Have you ever felt a sharp pain on the inside of your ankle after a long day on your feet? This may be posterior tibial tendinitis.
Posterior tibial tendinitis is an inflammation or irritation of the posterior tibial tendon, which is one of the major tendons of the lower extremity. This tendon connects a large muscle in the lower leg to certain bones on the inside of your foot. This tendon’s main purpose is to hold up our arches and stabilize the mid foot during walking or running.
Let’s talk about the cause, symptoms and treatment.
Causes of posterior tibial tendinitis
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Overuse:Repetitive activities like standing for long periods of time, running or hiking, especially on hard surfaces.
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Flat foot: One of the main purposes of the posterior tibial tendon is to hold up the arch so if you live with a flat foot or an overpronated foot, this tendon will end up working much harder than it was designed to, thereby creating vulnerability towards injury or overuse.
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Improper footwear: If you are participating in a high demand type activity while wearing a non-supportive shoe type, you will be susceptible to over-pronation and overuse of the posterior tibial tendon, which can ultimately lead to tendinitis.
- Certain risk factors:
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- Obesity- every step that we take we put 2 to 3 times bodyweight through each foot, and the average human takes anywhere from 8,000 to 10,000 steps per day.
- Aging-as we age our tendons lose elasticity and collagen content, reducing their strength and ability to handle stress.
- Underlying conditions such as diabetes, hypertension or prior ankle injuries. These conditions can cause damage to the collagen and tendons, reducing their elasticity and strength. Hypertension can cause damage to small blood vessels, reducing circulation to the poster tibial tendon, which also contributes to poor healing potential.
Symptoms
- Pain and/or swelling on the inside of the ankle just below the ankle bone, also known as the medial malleolus.
- Difficulty going up on your tippy toes. The posterior tibial tendon is one of the main muscles and tendons that aid in raising our heel off the ground. This is often evaluated by comparing the good leg with the painful leg.
- Flattening of the arch-since the posterior tibial tendons main function is to hold up the arch, if you notice your arch flattening relative to the other foot, this may be a sign of disease or injury to that tendon.
- Fatigue if your leg and foot may be due to overuse of the surrounding muscles and tendons due to the injured posterior tibial tendon.
Treatment
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Rest: this is the most important treatment option to recover from any tendinitis in the body. When tendons become irritated or inflamed, the only way for them to heal is to under use that tendon.
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Support: the severity of the tendinitis will ultimately determine the level of support needed. The most severe tendinitis may need a short leg fiberglass cast with crutches or a knee scooter. A moderate tendinitis may be treated by a walking immobilization boot. A milder tendinitis may be treated with a good supportive shoe combined with an ankle brace or elastic sleeve.
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Arch supports or Orthotics: again, since the main function of the posterior tibial tendon is to hold up the arch, an arch support or orthotic can greatly aid in the recovery of this tendinitis. As the arch support stabilizes the arch, this will allow the tendon to rest.
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Ice: as simple as it sounds, ice is very effective at reducing inflammation to the inured area. Too much swelling can interfere or slow down healing so it’s very important to reduce the inflammation.
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Nonsteroidal anti-inflammatories (NSAIDs): prescription anti-inflammatories can aid in the reduction of swelling and improve healing. Cortisone injections should be avoided for posterior tibial tendinitis.
- Physical therapy: after the tendon has gone through the rest phase and is on the way to getting better, it’s important to incorporate some high-quality physical therapy to help transition from a weakened leg to back to your normal level of expected activity.
Conclusion
Posterior tibial tendinitis is a manageable condition with early diagnosis and proper treatment
If your symptoms persist more than 3 to 5 days, it’s very important to see your local podiatrist. With an early diagnosis and proper care, you’ll be back to living with pain-free steps in no time.
Written by Jeffery S Hurless, DPM