Tibialis Posterior Tendinopathy – Pain around inside ankle bone

Many of us have started a new exercise schedule which may include walking or running more, as this is a good way to exercise in lockdown. However with this increase may come a new injury or a new tenderness. This blog is going to look at a more common ankle injury which requires attention to avoid chronic pain and in some cases a debilitating foot structure.

Tibialis posterior where it is and what it does

Diagram of the posterior tibial tendonThe tibialis posterior muscle originates at the back of our shin bone (tibia). It travels along the inside of our ankle turning from muscle into tendon, and attaches to inside bones of the foot (navicular and cuneiform). Its function is to support the arch of the foot, and helps provide control in this region. It provides movement of plantarflexion (up onto our toes) and inversion (turning the foot sole inwards).

Tibialis posterior tendonitis is an overuse injury causing inflammation of the Tibialis posterior tendon. Tendinopathy is probably a more accurate term to use as it refers to wear and tear or degeneration of the tendon rather than acute inflammation.

What are the symptoms of tibialis posterior tendinopathy?

Initial symptoms are reported to feel like a dull ache on the inside of your foot or around the inside of the ankle, and if the tendon has been overloaded you can experience sharp pain in the arch of the foot. This ache can be present in the morning and after periods of activity. The symptoms may start as a subtle pain or dull ache on the inside of the ankle and progress in intensity over time.

Pain can also be present when attempting to raise your heel from the ground.
If left untreated the tendinopathy can progress to a dysfunction of the tendon and you may be unable to rise up to tip toe from an initial flat foot position.

Causes

When a person begins a new sport or activity, or suddenly increase their current sport activity levels, this can overload the tendon. Overuse of this muscle can put strain on the tendon and cause micro damage over a period of time. Inefficient lower limb mechanics can place strain on the muscle causing it to repeatedly overstretch and overwork.

Long-term injuries to the tibialis posterior can result in insufficiency of the muscle and a condition called tibialis posterior dysfunction (PTTD) which results in adult acquired flat foot.

Treatment

Offloading the tendon will be required to allow it time to heal. This can be done with footwear advice and the use of a temporary orthotic device. Once symptoms are reduced rehabilitation is needed to build strength. The control of the arch is enhanced by the strength of not only the tibialis posterior but also the muscles higher up in the hip.

The tibialis posterior tendon injury will benefit from a multidisciplinary approach to prevent the symptoms progressing and provide immediate symptom relief.
Depending on the stage of your tibialis post tendinopathy will depend on the treatment options you will need.

What can you do to help yourself?

RICE is a good initial choice and this can be started at home (Rest, Ice Compression and Elevation). When pain allows, stretching exercises for the tibialis posterior and calf muscles could be started. Strapping/taping can be beneficial. Deep tissue massage to the tibialis posterior and calf muscles may help increase flexibility and condition of the muscles.

Of course not all ankle pain on the inside is due to tibialis posterior tendinopathy and it is advisable to seek medical advice from your local podiatrist before commencing any self care.

I will be creating another blog on strapping techniques which may be beneficial to you reading and trialling at home.

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