Posterior Tibialis Tendinosis

Posterior tibialis tendinosis is irritation and degeneration of a tendon called the posterior tibial tendon. Your posterior tibial tendon is a cord-like tissue that connects bones of your lower leg and foot to a muscle that:

• Supports your arch.
• Helps you raise up on your toes.
• Helps you turn your foot down and in.

This condition causes foot and ankle pain and can lead to a flat foot.

What are the causes?

This condition is most often caused by repeated stress to the tendon (overuse injury). It can also be caused by a sudden injury that stresses the tendon, such as landing on your foot after jumping or falling.

What increases the risk?

This condition is more likely to develop in:

• People who play a sport that involves putting a lot of pressure on the feet, such as:
  • Basketball.
  • Tennis.
  • Soccer.
  • Hockey.
• Runners.
• Females who are older than 40 years and are overweight.
• People with diabetes.
• People with decreased foot stability (ligamentous laxity).
• People with flat feet.

What are the signs or symptoms?

Symptoms of this condition may start suddenly or gradually. Symptoms include:

• Pain in the inner ankle.
• Pain at the arch of your foot.
• Pain that gets worse with running, walking, or standing.
• Swelling on the inside of your ankle and foot.
• Weakness in your ankle or foot.
• Inability to stand up on tiptoe.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Tests, such as:
  • An X-ray.
  • MRI.
  • An ultrasound.

During the physical exam, your health care provider may move your foot and ankle, test your strength and balance, and check the arch of your foot while you stand or walk.

How is this treated?

This condition may be treated by:

• Replacing high-impact exercise with low-impact exercise, such as swimming or cycling.
• Applying ice to the injured area.
• Taking an anti-inflammatory pain medicine.
• Physical therapy.
• Wearing a special shoe or shoe insert to support your arch (orthotic).

If your symptoms do not improve with these treatments, you may need to wear a splint, removable walking boot, or short leg cast for 6–8 weeks to keep your foot and ankle still.

Follow these instructions at home:

If you have a boot or splint:

• Wear the boot or splint as told by your health care provider. Remove it only as told by your health care provider.
• Do not use your foot to support (bear) your full body weight until your health care provider says that you can.
• Loosen the boot or splint if your toes tingle, become numb, or turn cold and blue.
• Keep the boot or splint clean.
• If your boot or splint is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight plastic bag when you take a bath or shower.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not apply lotion to the skin underneath the cast.
• Keep the cast clean.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your cast is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight plastic bag while you take a bath or a shower.

Managing pain and swelling

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If directed, apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Raise (elevate) your ankle above the level of your heart when resting if you have swelling.

Activity

• Do not do activities that make pain or swelling worse.
• Return to full activity gradually as symptoms improve.
• Do exercises as told by your health care provider.

General instructions

• If you have an orthotic, use it as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Wear footwear that is appropriate to your athletic activity.
• Avoid athletic activities that cause pain or swelling in your ankle or foot.
• Before being active, do range-of-motion and stretching exercises.
• If you develop pain or swelling while training, stop training.
• If you have pain or swelling that does not improve after a few days of rest, see your health care provider.
• If you start a new athletic activity, start gradually so you can build up your strength and flexibility.

Contact a health care provider if:

• Your symptoms get worse.
• Your symptoms do not improve in 6–8 weeks.
• You develop new, unexplained symptoms.
• Your splint, boot, or cast gets damaged.

Posterior Tibialis Tendinosis Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility in your ankle and foot. These exercises may also help to relieve pain.

Exercise A: Standing wall calf stretch, knee straight

1. Stand with your hands against a wall.
2. Extend your __________ leg behind you, and bend your front knee slightly. Keep both of your heels on the floor.
3. Point the toes of your back foot slightly inward.
4. Keeping your heels on the floor and your back knee straight, shift your weight toward the wall. Do not allow your back to arch. You should feel a gentle stretch in the back of your lower leg (calf).
5. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Standing wall calf stretch, knee bent

1. Stand with your hands against a wall.
2. Extend your __________ leg behind you, and bend your front knee slightly. Keep both of your heels on the floor.
3. Point the toes of your back foot slightly inward.
4. Unlock your back knee so it is bent. Keep your heels on the floor. You should feel a gentle stretch deep in your calf.
5. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your ankle and foot. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Ankle inversion with band

1. Secure one end of an exercise band or tubing to a fixed object, such as a table leg or a pole, that will stay still when the band is pulled. to an object that will not move if it is pulled on, like a table leg.
2. Loop the other end of the band around the middle of your left / right foot.
3. Sit on the floor facing the object with your __________ leg extended. The band or tube should be slightly tense when your foot is relaxed.
4. Leading with your big toe, slowly bring your __________ foot and ankle inward, toward your other foot.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Towel curls

1. Sit in a chair on a non-carpeted surface, and put your feet on the floor.
2. Place a towel in front of your feet. If told by your health care provider, add __________ at the end of the towel.
3. Keeping your heel on the floor, put your __________ foot on the towel.
4. Pull the towel toward you by grabbing the towel with your toes and curling them under. Keep your heel on the floor.
5. Let your toes relax.
6. Grab the towel with your toes again. Keep going until the towel is completely underneath your foot.

Repeat __________ times. Complete this exercise __________ times a day.

Balance exercises

These exercises improve or maintain your balance. Balance is important in preventing falls.

Exercise E: Single leg stand

1. Without shoes, stand near a railing or in a doorway. You can hold on to the railing or door frame as needed for balance.
2. Stand on your __________ foot. Keep your big toe down on the floor and try to keep your arch lifted. If balancing in this position is too easy, try the exercise with your eyes closed or while standing on a pillow.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.