Tibialis Posterior Tendonitis

Overview of Tibialis Posterior Tendonitis

Tibialis posterior tendinitis, sometimes referred to as tibialis posterior tendon dysfunction, is a relatively common condition that affects the medial side of the ankle. 

Tendinitis refers to the inflammation of the tendon in response to overuse or overstretching. Prolonged and more chronic cases of the condition can lead to tearing or rupture of the tibialis posterior tendon which is sometimes referred to as tibialis posterior tendon insufficiency.

Anatomy of the Tibialis Posterior 

Anatomical image of leg skeletons with the tibialis posterior muscle shown in isolationanatomy of Posterior tibialis

The tibialis posterior muscle arises from the inside or medial part of the calf and becomes a tendon just above the ankle. Because of its shape and action, its main job is to support the arch of the foot when walking. It also acts to move the foot towards the opposite side in non-weightbearing positions.

How Does Posterior Tibialis Tendonitis or PTT Happen?

Though performing high intensity activities such as running or repetitive loading activities such as basketball or soccer are often a common contributing factors to the development of Tibialis posterior tendinitis, this condition can also arise from a prolonged standing job or excessive walking. 

Here are some reasons you can develop PPT:

  • Chronic or long-standing tendinitis can develop tears in the tendon which will lead to disruption of the integrity of the arch of the foot.
  • Having extreme dysfunction of this tendon will develop severe flatfoot as the tendon becomes unable to maintain the structure of the arch.   
  • Other contributing factors include obesity and diabetes and tibialis posterior tendonitis tends to be more common in women than men.
  • This condition is typically characterized by pain on the inside part of the foot just behind the medial malleolus or the large ankle bone on the inside of the ankle.  
  • Pain is typically worse after prolonged standing or prolonged walking and is typically aggravated by barefoot activities.  
  • Pain may also be present with actively moving the ankle inwards towards the other leg. Patient may also experience swelling along the inside portion of the ankle and can occasionally feel popping of the tendon as it moves around the ankle with movement.

Image of the medial foot and ankle anatomy with labels for tibialis posterior, flexor digitorum longus, and flexor hallicus longus

Treatment for Posterior Tibialis Tendonitis

Treatment for tibialis posterior tendonitis typically includes a period of rest and may require prolonged immobilization and a removable walking boot. 

Patients with this condition are instructed to maintain good arch support in their shoes and to avoid flat footwear such as flip-flops and are instructed to avoid going barefoot.    

Physical therapy for this condition includes specific stretching exercises need to be performed on a regular basis to improve ankle mobility. Exercises to strengthen the intrinsic muscles of the foot are also helpful to improve arch strength and integrity.  

Physical therapy may also include modalities such as laser therapy, Graston instrument assisted soft tissue mobilization and utilize specific joint and soft tissue mobilization techniques to help assist in functional recovery.

By: Drew Heideman, PT ATC

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