What is posterior tibial tendonitis? It is an overuse injury of a muscle on the inside of the foot that holds up the arch.  This muscle spans from the leg to the inside aspect of the foot and can be come irritated, strained or torn.  This condition is a result of improper biomechanics, whereby the structure of the foot places strain on the tendon during walking and running.  When irritated, the tendon becomes inflamed and attenuated.

How is this treated?  Because the condition is comprised of inflammation and poor foot mechanics, both of these need to be addressed for treatment.

  • First appointment: At your first appointment, your doctor will examine your feet and take x-rays of the painful foot to rule out other causes of pain and also to assess if there is an accessory bone or coalition present.  If you are diagnosed with posterior tibial tendonitis, there are two main causes to your pain that need to be addressed.
    • Inflammation: This is what causes your ankle to be painful.  Inflammation can be managed with oral non-steroidal anti-inflammatories, icing, and in some cases topical anti-inflammatory medicines.  These methods are typically needed only in the first few weeks of treatment.
    • Biomechanics: The predisposing factor in posterior tibial tendonitis is when the heel is not properly aligned and the posterior tibial tendon takes on more strain than normal.  This is often caused by a flat or overly flexible foot.
      • Strappings and Braces: These are dispensed on your first appointment to provide more support to your posterior tibial tendon to avoid that additional strain.  These are removable, but are to be worn at all times, even at home while barefoot. 
      • Walking Boot: Depending on the severity or acuity of your injury, your doctor may recommend more support and off weighting of the inside aspect of the foot.  A walking boot provides this.
      • Strengthening: Your doctor may provide you with instructions on exercises to perform that improve strength of the tendon and better supports the arch of the foot.
  • At your first follow-up: Your doctor will re-assess your condition and determine what the next step needs to be.
    • If your condition is nearly 100% improved the focus of treatment is to prevent recurrence of the condition.  When the acute pain is reduced, this tells us that your inflammation has nearly completely resolved.  This places our focus next onto ensuring that biomechanics are corrected and that your feet are kept in a neutral position with good alignment of the heel. 
      • Custom orthotic inserts allow optimal support of your heels and feet to prevent further strain on the posterior tibial tendon.  If custom orthotics are recommended to you at your follow-up the next step is an appointment with our trained staff to obtain an impression of your feet.
    • If your condition has not improved, this tells your doctor that the next step will be implementation of additional therapies.
      • Physical Therapy: In some instances, the at-home strengthening , anti-inflammatories and icing are not be completely effective in reducing inflammation and alleviating posterior tibial tendonitis.  In tougher cases, physical therapy can be the key to getting better.  There are various techniques provided by physical therapists in your area that can help get on the road to healing.
      • If your condition is the same or worse: In some instances if improvement is evident at your follow-up visit, your doctor may order an MRI or CT scan to explore the possibility of tears within the tendon or presence of accessory bone that can be impeding your recovery.
  • If things aren’t improving: If you have stubborn posterior tibial tendonitis even after the above mentioned treatment, your doctor will re-assess you to determine the next course of treatment.
    • Further Studies such as obtaining an MRI or CT scan of the ankle is sometimes necessary to ensure that there are no other underlying coalitions or torn/damaged tissue that may be complicating your recovery.  These  do not always show up on x-ray.
    • Surgery: Surgery is an option in some cases of posterior tibial tendonitis.  Surgical intervention is patient and condition-specific.  In any given case, there may be a need to remove damaged tissue and repair tears.  In other instances, coalitions or accessory bones may need to be removed.  In yet other cases, there may be a need to reconstruct the foot to relieve pressures causing the foot to be predisposed to tendon injury.

As you can see, posterior tibial tendonitis is a multifaceted diagnosis which requires strict adherence to at home therapies, as recommended by your doctor.  It can be a very difficult condition to resolve, but there are many treatments available to ensure that you get back to your regular activities without pain.