You've got lots of tendons in your foot and leg, but one of the most important is the posterior tibial tendon. It links the calf muscle to the bones on the inside of the foot. It has a big job, so when it becomes inflamed or injured, it has a big impact on your daily life.
If you're having pain in your inner arch, heel or ankle, it's time to make an appointment with a medical professional to get checked out. Getting a diagnosis is the first step to figuring out your treatment options and, if you have a progressive condition like posterior tibial tendonitis, addressing it before it gets worse.
You won't be surprised to hear that symptoms of posterior tibial tendonitis are centered around your inner foot and ankle, right where the tendon is in your foot and leg.
Ignoring posterior tibial tendonitis symptoms 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.
Common symptoms include:
According to the American Academy of Orthopaedic Surgeons, the most common causes of posterior tendon dysfunction are injuries and overuse:
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.
Through an examination of your foot and leg, your doctor will look for the following:
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.
Your doctor may also order imaging studies to take a closer look at what is going on inside your foot:
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 for posterior tibial tendon dysfunction include:
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.
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.
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.
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.
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.
Early intervention of posterior tibial tendonitis is key to reduce damage to your foot and ankle. Orthotic insoles are often recommended as a nonsurgical treatment. They provide support, correct biomechanical irregularities in your foot, and limit the progression of your foot’s malfunction.
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