Posterior Tibial Tendon Injury

What is a posterior tibial tendon injury?

Tendons, are strong bands of connective tissue that attach muscle to bone. A strain is a stretch or tear of a muscle or tendon. Tendinopathy is when a tendon is inflamed. When there are micro-tears in a tendon from repeated injury it is called tendinosis. Tendinopathy is the term for both inflammation and micro-tears.

The posterior tibial tendon helps point the foot down and in. Posterior tibial tendinopathy causes pain along the inner side of the lower leg, ankle or foot.

How does it occur?

Posterior tibial tendinopathy occurs from overuse of the tendon. This tendon attaches to a bone in the foot called the navicular and helps stabilize your arch. If your arch flattens out more than normal when you walk or run it is called over-pronation. When you over-pronate you strain your tendon and are more likely to get posterior tibial tendinopathy.

What are the symptoms?

Symptoms include:

• pain or tenderness on the inner side of the shin, ankle or foot
• pain with lifting up your foot
• pain walking or running

How is it diagnosed?

Your healthcare provider will review your symptoms and examine your leg, ankle and foot. Your foot will be tender along the tendon and where it attaches to the navicular bone. You may be asked to walk or run to see if you over-pronate.

How is it treated?

To treat this condition:

• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
• You could also do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over your tendon for 5 to 10 minutes. Do this several times a day while you have pain.
• Raise your lower leg and foot on a when you sit or lie down.
• Your healthcare provider may recommend shoe inserts, called orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made.
• Sometimes a cast is needed for a few weeks until the pain and inflammation go away. Taping your foot can give extra support to your arch, the navicular bone and the attachment of the posterior tibial tendon.
• Use crutches until you can walk without pain.
• Take an anti-inflammatory such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• Follow your provider’s instructions for doing exercises to help you recover.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your injured tendon recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured leg and foot compared to the uninjured leg and foot.
• You have full strength of the injured leg and foot compared to the uninjured leg and foot.
• You can walk straight ahead without pain or limping.