Posterior Tibial Tendonitis Causes, Symptoms & Treatment

Tendons are strong, cord-like tissues that connect muscles to bones. The posterior tibial tendon runs from the calf muscles, down the inside of the ankle, and to the bones of the foot. This important tendon holds up your foot, maintains your arch, and is essential for walking. Dysfunction of the posterior tibial tendon is a common problem that happens when the tendon becomes inflamed or torn. Collapse of the arch of the foot occurs with increasing severity of tendonitis or rupture of this tendon. Doctors often classify a patient’s level of posterior tibial tendon dysfunction in four progressive stages of severity, with stage 4 representing the highest level of posterior tibial tendon failure.

Posterior tibial tendon dysfunction often happens due to repetitive overuse. Dancers and athletes who play high impact sports are at risk due to the stress they place on this tendon. An acute injury, such as a fall or collision, can also tear the posterior tibial tendon.

Posterior tibial tendon dysfunction is most common in these sports:

• Dancing
• Tennis
• Basketball
• Soccer

Pain on the inside of the foot and ankle, where the posterior tibial tendon lies, is a common symptom of this condition. Pain may get worse with activity. Other common symptoms include:

• Swelling
• Difficulty running or walking
• A gradual flattening of the arch
• In advanced cases, the heel may push outwards and pain may be felt on the outside of the foot

If left untreated, posterior tibial tendon dysfunction may get progressively worse and treatment will become more invasive. That’s why If you have symptoms of this condition, it’s important to see your doctor. To make a diagnosis, your doctor will take a medical history and ask about your physical activity. A physical examination will be conducted, looking for tenderness along your tendon, swelling, stiffness and signs of deformity to your foot and ankle.

To test the integrity of the tendon, your doctor may ask you to stand on your affected foot and rise up on your toes (called the single limb heel rise). Another common test involves looking at your heel from behind to see if the fourth and fifth toes are visible. If they are, you may have suffered a loss of your arch, a sign of advanced stage dysfunction. To help confirm the diagnosis and detect the presence of arthritis, x-rays and other imaging tests such as a magnetic resonance imaging (MRI) test may be ordered.

Non-surgical treatments are usually successful in treating posterior tibial tendon dysfunction in its earlier stages. Treatment focuses on allowing your tendon to heal as well as relieving pain and other symptoms. Avoiding activities that cause pain and place repeated stress on your foot is important for allowing the healing process to take place. Common treatments also include:

• Applying ice and elevating your foot to reduce swelling and pain
• Using crutches if walking is painful
• Wearing a cast or special boot to immobilize and support your foot or orthotic shoe inserts with arch support
• Anti-inflammatory medication for pain relief
• Physical therapy
• In rare cases a cortisone injection, a powerful anti-inflammatory pain reliever, may be recommended

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Posterior Tibial Tendonitis

If conservative treatments aren’t successful within six months, or in advanced stages of posterior tibial tendon dysfunction, surgery may be considered. The type of surgery will depend on the stage of dysfunction. In earlier stages, a surgical procedure called debridement, which involves cleaning away and removing inflamed or torn tissue, may be effective. Another surgical procedure replaces the damaged posterior tibial tendon with a healthy tendon transferred from the foot.

In more advanced cases where the arch has collapsed, your surgeon may recommend a procedure called osteotomy, which involves cutting and shifting bones in the foot to reconstruct the arch. In the most severe cases, surgeons may fuse the joints in your foot together, using screws and plates, to realign the foot.

Recovery from posterior tibial tendon dysfunction will depend on the stage of the disease and the type of treatment. Athletes treated conservatively usually can get back to normal activities within a few weeks. Advanced cases treated surgically may require a recovery that lasts three months or more. While outcomes from surgery are generally positive, some athletes with severe tendon damage may not regain their full range of motion or be able to return to high impact sports. Your doctor will advise on the type of surgery needed, the risks of surgery, and how to maximize your ability to achieve a full recovery.