Posterior Tibial Tendonitis: Symptoms, Causes, & Treatments
Updated February 17, 2023.
The posterior tibial tendon and the muscles it influences play an essential role in walking and supporting the medial arch. It is the second largest of the extrinsic foot tendons and connects one of the calf muscles to the bones located on the inner foot. Thus, its action causes the foot to plantarflex (flex the toes towards the sole).
When this tendon becomes inflamed, it causes posterior tibial tendonitis, otherwise known as posterior tibial tendon dysfunction (PTTD), and also affects the inner side of the ankle, called the medial malleolus. This often happens because of the compression of the tendon and poor blood supply to the area. Posterior tibial tendonitis is quite common and can become a real problem if not managed promptly.
Symptoms of Posterior Tibial Tendonitis
At the initial stage, posterior tibial tendonitis is characterized by inner foot pain that worsens with activity, swelling and tenderness along the tendon, inability to stand on one foot, an inward rolling of the ankle, turning out of the toes and foot, and unsteady gait.
However, posterior tibial tendonitis is progressive and usually goes through 4 stages, each with varying levels of symptoms and deformities:
- Stage 1 is the least symptomatic stage where it is possible to miss the diagnosis.
- In stage 2, there is a torn tendon that affects the normal functioning of the foot.
- At stage 3, there is sizeable deformation of the foot along with degeneration of the connective tissue in the hindfoot.
- By stage 4, the inflammation is full-blown with deltoid ligament compromise and degenerative changes at the ankle joint.
» Read more about the four stages of PTTD and their diagnoses
Causes of Posterior Tibial Tendonitis
There can be multiple different causes of posterior tibial tendonitis, such as:
- Acute injury A fall or high-impact activity can tear the tendon or cause it to become inflamed.
- Overuse/high-impact sports This is especially common in athletes and sports professionals who play high-impact sports, such as basketball, tennis, or soccer.
In addition to these direct causes, obesity, diabetes, and hypertension are considered risk factors, and statistically speaking, females and individuals over 40 are more likely to suffer from this condition.
Treatment of Posterior Tibial Tendonitis
There are many different treatment options available for PTTD before surgery is necessary, which include the following:
Like many other injuries to the foot joint, rest is the first line of management. While total abstinence may be impossible to achieve, activity modification may prove more successful. You can limit walking on the foot to the barest minimum and avoid high-impact activities like running, jumping, jogging, etc.
2. Ice and NSAIDs
Next to rest is the use of ice and non-steroidal anti-inflammatory drugs (NSAIDs). At the acute phase, these can be used to control inflammation and thus reduce symptoms.
Braces can support the foot joints and reduce strain on the posterior tibial tendon. Utilizing a brace early enough can limit the progression of PTTD as well as relieve pain, strengthen the tendons, and aid in the healing process.
ROM exercises for the ankle (passive or active) will help you maintain optimal mobility. This will allow you to move fully and without pain in all directions, so stiffness and other complications do not result. General flexibility exercises can also improve mobility in the lower limb muscles while maintaining foot alignment in walking.
» Learn how to alleviate any possible discomfort with the best exercises for posterior tibial tendonitis
5. Custom Orthotics
Using custom orthotics is another early treatment option. Upstep orthotics are particularly useful in treating this condition as they can relieve pain and improve your mobility. Additionally, they support the foot and help restore normal foot position. Upstep orthotics are helpful because they are tailored to your specific condition regardless of the stage or severity of your symptoms.
When pain persists despite conservative treatments at the early stages, surgery becomes the only option left. The surgical approach depends on the location of the tendonitis and the severity of the damage. Standard surgical procedures include lengthening of the calf muscles, tenosynovectomy, tendon transfer, osteotomy, and fusion.
Posterior Tibial Tendonitis Relief
Posterior tibial tendonitis causes pain on the inner side of the foot and ankle. When it occurs, it causes instability while walking. Posterior tibial tendonitis must be managed early on while it can still be easily managed. Otherwise, it can lead to avoidable complications and deformities like adult-acquired flatfoot.
Once consistent inner foot pain is identified, ensure you see a doctor. The doctor will examine your foot and sometimes call for an MRI. While this may sound scary, if a diagnosis of posterior tibial tendonitis is arrived at, know that it can be effectively managed with correct medical supervision.