Posterior Tibial Tendonitis - Causes, Symptoms & Treatment Options

by Mark Paigen November 08, 2018

Posterior tibial tendonitis (also known as post tib tendonitis) is a progressive condition that occurs when the posterior tendon that links the calf muscles to the bones inside the foot becomes inflamed or injured. Learn more about this condition below, including symptoms, risk factors and potential treatment options.

Symptoms of Posterior Tibial Tendonitis

If you suffer from pain or swelling of the inner or outer ankle or heel, speak to a doctor. While many of the symptoms of post tib tendonitis may be addressed non-surgically, ignoring them can lead to progressive damage to the tendon and cause your foot’s arch to fall. Left untreated, the condition can deteriorate into flat-footedness or require surgical intervention to correct.

Here are some common symptoms:

  • Redness, swelling, or pain on the inner arch, heel, or ankle (most common area impacted)
  • Redness, swelling, or pain on the outer ankle or back of heel
  • Foot pain that increases with running, jumping, or climbing
  • Foot pain after long periods of standing or walking a short distance

Causes & Risk Factors

The most common causes of posterior tendon dysfunction are injuries and overuse:

  • Injury. A tendon sprain or tear is a common injury that can lead to post tib tendonitis.
  • Overuse. Participating in sports that require a lot of jumping, running, or repetitive impacts to the foot can increase risk.
  • Weight. Overweight and obese people are at higher risk due to increased stress on the tendon.
  • Age. More common in those over 40 years old.
  • Sex. Women are more likely than men to develop the condition.
  • Hypertension. Those with high blood pressure are at higher risk.

Diagnosis

If you suspect you may be suffering from posterior tibial tendonitis, visit your podiatrist. Diagnosis usually takes place through a combination of physical examinations and imaging tests.

Physical Examination

Through an examination of your foot and leg, your doctor will look for the following:

  • Lower leg and ankle swelling, especially along the tendon
  • A change in the shape of your foot, such as a collapsing arch
  • An outward turning heel, with the toes askew from the ankle

These symptoms are indicative of progressive posterior tibial tendonitis. Your doctor may ask you to rise to a tiptoe position while standing on one leg. Trouble with this task or an inflexibility in the ankle may be also be suggestive of the disorder.  

Imaging Examination

Your doctor may also order imaging studies to take a closer look at what is going on inside your foot:

  • X-Rays of the bones can rule out other issues like arthritis, a fracture, or problems with bone density.
  • Magnetic Resonance Imagery (MRI) can allow your doctor to observe your muscles, tendons, and soft tissues to see if there is evidence of tendonitis.
  • CT Scans will provide a cross-sectional view of your foot and help your doctor differentiate conditions like arthritis and tendonitis, making a clear diagnosis easier.
  • Ultrasounds may be ordered if you need a more definitive imaging analysis.

Posterior Tibial Tendonitis Treatment Options

It can take between 6 to 9 months (or longer) for symptoms to improve and your tendon to heal. The most important factor in your recovery is immobilizing the foot as much as possible during the healing process. Depending on the severity, your health care provider may recommend a combination of nonsurgical and surgical treatments.

Nonsurgical Treatments

Nonsurgical treatments for posterior tibial tendon dysfunction include:

  • Resting the foot and applying ice for 20 minutes at a time, several times a day
  • Physical therapy
  • Orthotic shoe insoles
  • Leg, foot, or ankle braces
  • Non-steroidal anti-inflammatory medications for pain and swelling
  • Cortisone injections to the tendon

Surgical Treatments

Surgical intervention may be necessary if your symptoms do not respond to non-surgical treatment. Depending on the location and level of damage to your tendon, your surgeon may consider one of the following procedures:

Lengthening the Achilles Tendon (Gastrocnemius Recession)

For patients unable to lift their ankle, this surgery increases the calf muscle span and may prevent the recurrence of flat footedness. Possible complications include damage to the nerves, muscle weakness, and difficulty going up stairs or pushing up to the toes.

Tendon Cleaning (Tenosynovectomy)

For early stages of posterior tendonitis that do not respond to non-surgical types of treatment, this surgery involves removal of the damaged or inflamed tissue around the tendon.

Tendon Transfer

Your surgeon may replace the damaged tendon with a functioning tendon from another part of your foot if you suffer from flexible flatfoot. If the tendon is not too degraded, they may fuse it to a functioning tendon to create additional support and function. While this surgery can restore function to the posterior tendon, it will most likely cause a disruption elsewhere in the foot, and you may not be able to run, jump, or participate in other athletic activities post-surgery.

Joint Fusion

When you have flat-footedness and stiffness caused by arthritis, your surgeon may perform arthrodesis (fusion) of the foot joints to create a better foot alignment. Damaged or healthy cartilage may be removed and replaced with a temporary metal plate and screws until new tissue bonds the bones and your foot heals. Complications include a loss of side-to-side motion in the foot post-surgery, but your up-and-down motion and pain may improve. If the bones do not properly knit together, you may need a second surgery.

Osteotomy

This surgery involves cutting and relocating bones in your foot to stabilize your arch. Depending on the severity of your condition, you may require a bone graft and temporary plates and screws to lengthen your heel.

Prognosis After Surgery

Even with a successful surgical outcome, it may take up to one year before your pain subsides completely and full foot function returns. Generally, the earlier you can address your tendon dysfunction, the better and quicker your post-surgical outcome will be. More severe cases of flat-footedness and those with limited foot function prior to surgery will likely take longer to heal.

Tread Labs Insoles Can Help

Early intervention of posterior tibial tendonitis is imperative to reduce damage to your foot and ankle. Orthotic insoles are often recommended as a nonsurgical treatment that provides support, corrects biomechanical irregularities in your foot, and limits the progression of your foot’s malfunction.

Visit Why Tread Labs for more information on how our semi-custom, medical-grade orthotic inserts can help reduce and manage your foot pain symptoms.

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Mark Paigen
Mark Paigen


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