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Tibialis Posterior TendonitisInjuries > Ankle > Tibialis Posterior Tendonitis
(Also known as Tibialis Posterior Tendiopathy, Posterior Tibial Tendinitis, Tibialis Posterior Tendinosis)N.B. Although recent research suggests that 'tibialis posterior tendinopathy' is the more appropriate term to describe overuse injuries to the tibialis posterior tendon, we will use the term 'tibialis posterior tendonitis' in this document as it is more widely known. What is tibialis posterior tendonitis?The tibialis posterior muscle originates from the back of the tibia and fibula (lower leg bones), it then travels down along the inside of your lower leg and ankle where it inserts into various bones in the foot via the tibialis posterior tendon (figure 1). The tibialis posterior muscle is responsible for moving the foot and ankle towards the midline of the body (inversion – figure 2) and pointing the foot and ankle down (plantarflexion – figure 3). It also helps to maintain the normal arch of your foot. Whenever the tibialis posterior muscle contracts or is stretched, tension is placed through the tibialis posterior tendon. If this tension is excessive due to too much force or repetition, damage to the tibialis posterior tendon may occur. Tibialis posterior tendonitis is a condition where there is damage to the tendon with subsequent inflammation and degeneration. This may occur traumatically due to a high force going through the tendon beyond what it can withstand or more commonly due to gradual wear and tear associated with overuse. Signs and symptoms of tibialis posterior tendonitisPatients with tibialis posterior tendonitis typically experience pain in the region of the inner lower leg and ankle. In less severe cases, patients may only experience pain with rest following activities requiring strong or repetitive contraction of the tibialis posterior muscle such as running (especially uphill or on uneven surfaces), jumping, hopping etc. They may also experience pain and stiffness upon waking the following morning. As the condition progresses, patients may also experience pain during these activities affecting performance. The pain associated with this condition tends to be of gradual onset which progressively worsens over weeks to months with continuation of aggravating activities. Patients with this condition may also experience pain on firmly touching the tibialis posterior tendon (figure 1). Diagnosis of tibialis posterior tendonitisA thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a tibialis posterior tendonitis. Diagnosis may be confirmed with an MRI scan or ultrasound investigation. Treatment for tibialis posterior tendonitisMost patients with tibialis posterior tendonitis heal well with an appropriate physiotherapy program. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free (crutches may be required). This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Once chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence. Immediate appropriate treatment in all patients with tibialis posterior tendonitis is vital to ensure an optimal outcome. Following the R.I.C.E. Regime with regular icing and anti-inflammatory medication may help to significantly reduce inflammation in the initial phase of this condition. A graduated flexibility, balance and strengthening program under direction from a physiotherapist is vital to ensure an optimal outcome. In the final stages or rehabilitation, a gradual return to activity or sport should occur under guidance from the treating practitioner and provided there are no increase in symptoms. Contributing factors to the development of tibialis posterior tendonitisThere are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist and may include:
Physiotherapy for tibialis posterior tendonitisPhysiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence in all patients with tibialis posterior tendonitis. Treatment may comprise:
Prognosis of tibialis posterior tendonitisMost patients with this condition heal well with an appropriate physiotherapy program. This, however, can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early physiotherapy treatment is vital to hasten recovery and ensure an optimal outcome. Other Intervention for tibialis posterior tendonitisDespite appropriate physiotherapy management, a small percentage of patients with this condition do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, Ultrasound, CT scan or MRI, corticosteroid injection, autologous blood injection, pharmaceutical intervention or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics and appropriate footwear advice may also be indicated. Exercises for tibialis posterior tendonitisThe following exercises are commonly prescribed to patients with this tibialis posterior tendonitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms. Foot and Ankle Up and DownMove your foot and ankle up and down as far as possible and comfortable without pain (figure 3). Repeat 10 - 20 times provided there is no increase in symptoms.
Figure 3 – Foot and Ankle Up and Down (left leg) Foot and Ankle In and OutMove your foot and ankle in and out as far as possible and comfortable without pain (figure 4). Repeat 10 -20 times provided there is no increase in symptoms.
Figure 4 – Foot and Ankle In and Out (right leg) Lunge StretchWith your hands against the wall, place your leg to be stretched in front of you as demonstrated (figure 5). Keep your heel down. Gently move your knee forward over your toes as far as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided there is no increase in symptoms.
Figure 5 – Lunge Stretch (right leg)
Find a Physio for tibialis posterior tendonitisFind a physiotherapist in your local area who can treat tibialis posterior tendonitis.
Other ankle exercisesView more ankle flexibility exercises. View ankle strengthening exercises. View balance exercises.
Physiotherapy products for tibialis posterior tendonitisSome of the most commonly recommended products by physiotherapist for patients with this tibialis posterior tendonitis include:
To purchase physiotherapy products for tibialis posterior tendonitis click on one of the above links or visit the PhysioAdvisor Shop.
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Figure 1 - Tibialis posterior muscle and tendon
Figure 2 - Inversion
Figure 3 - Plantarflexion
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