Posterior tibial tendonitis, also known as posterior tibial tendon dysfunction (PTTD), involves inflammation or degeneration of the posterior tibial tendon. This tendon extends from a calf muscle down the inside of the ankle and attaches to bones in the midfoot. It plays a significant role in supporting the foot’s arch and facilitating foot movement. When this tendon experiences issues, it can impact the foot’s structural integrity and function.
Understanding Posterior Tibial Tendonitis
The posterior tibial tendon is a strong cord of tissue on the inner side of the ankle and foot, connecting the posterior tibialis muscle in the calf to bones within the foot. Its primary function is to help maintain the arch of the foot and assist with movements like pointing the foot downward and turning it inward. When this tendon is compromised, it impairs its ability to support the arch, potentially leading to a gradual flattening of the foot.
Posterior tibial tendonitis often results from repetitive stress or overuse, causing tiny tears in the tendon fibers. Activities such as running, hiking, or prolonged standing without proper support contribute to this strain. Other factors increasing risk include aging, previous foot or ankle injuries, flat feet, certain inflammatory conditions like rheumatoid arthritis, and being overweight.
Individuals with posterior tibial tendonitis typically experience pain along the inside of the ankle and foot, particularly during or after physical activity. Swelling along the tendon’s path, tenderness, and difficulty standing on the toes are common symptoms. As the condition progresses, the arch may visibly flatten, and the ankle might appear to roll inward, sometimes leading to pain shifting to the outside of the foot.
Initial Home Management and Non-Invasive Care
Managing posterior tibial tendonitis begins with home strategies. Rest from activities that aggravate the tendon is important to reduce inflammation and allow healing. Applying ice to the affected area for 15-20 minutes several times a day can help alleviate pain and swelling. Compression, such as an elastic bandage, and elevating the foot above heart level can further minimize swelling.
Modifying daily activities to reduce stress on the tendon is also beneficial. This involves avoiding high-impact exercises like running or jumping and opting for lower-impact alternatives. Over-the-counter pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs), can help manage pain and inflammation.
Choosing supportive footwear is an effective step. Shoes with good arch support and firm heels can help stabilize the foot and reduce strain on the tendon. Over-the-counter arch supports or shoe inserts can provide additional stability and comfort, especially in the early stages of the condition. Gentle stretching exercises for the calf muscles and Achilles tendon can also be introduced to improve flexibility, but these should be performed without causing increased pain.
Medical Treatments and Professional Guidance
If home care measures do not relieve symptoms, or if pain worsens and foot shape changes are noticed, seeking professional medical advice is necessary. A healthcare provider diagnoses the condition through a physical examination, assessing pain, swelling, and the foot’s arch. They may also perform tests like the single-limb heel raise, where the inability to stand on toes or an inward rolling of the heel can indicate tendon dysfunction. Imaging techniques such as X-rays or MRI scans evaluate tendon damage and any associated foot deformities.
Non-surgical medical treatments are the first line of intervention. Custom orthotics, specialized shoe inserts, are often prescribed to provide tailored arch support and control excessive foot motion, thereby reducing stress on the posterior tibial tendon. A brace or walking boot may be used to immobilize the foot and ankle, allowing the tendon to rest and heal, particularly in more severe cases.
Formal physical therapy plays a significant role in recovery. A physical therapist guides patients through specific exercises to improve range of motion, strengthen the posterior tibial muscle and surrounding foot and ankle muscles, and enhance overall foot mechanics. Corticosteroid injections may reduce localized inflammation, though their use is often limited due to potential risks like tendon weakening or rupture. For cases that do not respond to conservative management, surgical options may be discussed, ranging from cleaning the tendon to more complex procedures to repair or reconstruct the tendon and realign foot bones.
Rehabilitation and Preventing Recurrence
A structured rehabilitation program is for long-term recovery and preventing the recurrence of posterior tibial tendonitis. This program, overseen by a physical therapist, focuses on strengthening the posterior tibial muscle and other supporting muscles in the leg and foot. Exercises may include resistance band movements for ankle inversion and plantarflexion, calf raises, and specific exercises like foot doming to rebuild strength and capacity.
Balance and proprioception exercises improve the body’s awareness of foot position and enhance stability. Activities like standing on one leg or using balance boards retrain the neuromuscular system, which supports proper foot mechanics. As the tendon heals and strength improves, a gradual return to activity is advised, avoiding sudden increases in intensity or duration. This measured approach helps prevent re-injury by allowing the tendon to adapt to increasing demands.
Maintaining a healthy weight reduces overall stress on the foot and ankle. Consistent use of supportive footwear, including custom orthotics if prescribed, provides ongoing support to the arch and maintains proper foot alignment even after symptoms subside. These lifestyle adjustments, combined with a dedicated exercise routine, are important for sustaining recovery and minimizing the likelihood of future issues.