Posterior Tibial Tendonitis

Patients often come in with self-diagnosed “ankle pain”. They point to the inside of

the ankle and towards the instep. Upon examination the pain is many times not from

the ankle at all but rather a tendon that courses behind the inside ankle bone (medial

malleolus) and inserts into the rearfoot bone known as the navicular. This tendon is

called the posterior tibial tendon and helps act as a stirrup to hold up the arch. Sometimes

the tendon itself becomes thickened (degenerated) and/or the sheath surrounding the

tendon becomes inflamed. Both of these conditions can cause pain and are treated

similarly.

 

muscular foot anatomyThe goal of treatment is to help reduce the load and tension on the tendon. For acute cases where there is notable swelling and the patient is limping, immobilization in a fracture boot for several weeks is warranted. Ice, rest, elevation and anti-inflammatories are also important during this time. Once the pain and swelling improves then physical therapy is necessary to properly rehabilitate the tendon and help return to normal function. Custom orthotics are necessary for long-term treatment as well as to help prevent future flare ups. Supportive shoes are also critical. The shoe must have a wide sole and not bend from the heal toe the big toe joint. Occasionally the tendon becomes so strained that the foot starts to progressively flatten. These feet can often be helped with orthotics but some warrant surgical reconstruction.

 

It is very important to see your podiatrist if you think you have “ankle pain” since it’s not

always the ankle. If the posterior tibial tendon is angry and gets ignored, it can lead to

chronic foot and ankle problems that otherwise could have been prevented!

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