Common Diagnoses:
Posterior Tibialis Tendinitis

Overview

The posterior tibial tendon is one of the most important tendons in your lower extremities. Its purpose is to stabilize your ankle. It is the tendon that makes it possible for you to point your foot in several directions.

This tendon is prone to overuse injuries that cause inflammation and a host of other symptoms in the ankle and foot. Posterior tibial tendonitis is a common foot and ankle injury, particularly among those who play sports, dancers, and gymnasts. It also affects those with highly active lifestyles and hobbies.

Symptoms

Most commonly, patients with posterior tibial tendonitis complain of pain on the inner of the foot and ankle and occasionally have problems associated with an unsteady gait. Many patients report having had a recent ankle sprain, although some will have had no recent injury.

As posterior tibial tendonitis progresses, the arch of the foot can flatten and the toes begin to point outwards. This is the result of the posterior tibial tendon not doing its job to support the arch of the foot.

Diagnosis

Diagnosis of posterior tibial tendonitis is commonly made by physical examination. Patients have tenderness and swelling over the course of the posterior tibial tendon.

Usually, they have weakness inverting their foot (pointing the toes inward). Also common in patients with posterior tibial tendonitis is an inability to stand on their toes on the affected side.

When the examination is unclear, or if a patient is considering surgery, a magnetic resonance imaging (MRI) scan may be obtained. The MRI is an effective method to detect ruptures of the tendon, and it can also show inflammatory changes surrounding the tendon.

Treatment

The initial treatment of posterior tibial tendonitis is focused on resting the tendon to allow for healing.4 Unfortunately, even normal walking may not adequately allow for the tendon to rest sufficiently. In these cases, the ankle must be immobilized to allow for sufficient rest.

Options for early treatment include:

  • Shoe inserts and arch supports
  • Walking boots
  • Casts

By providing a stiff platform for the foot, shoe inserts and walking boots prevent motion between the midfoot and hindfoot. Preventing this motion should decrease the inflammation associated with posterior tibial tendonitis.

Casts are more cumbersome but are probably the safest method to ensure the posterior tibial tendon is adequately rested.

Other common treatments for early-stage posterior tibial tendonitis include anti-inflammatory medications and activity modification.4 Both of these treatments can help to control the inflammation around the posterior tibial tendon.