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(Posterior Tibial Tendonitis; Posterior Tibial Tendinosis)

Definition

Posterior tibial tendinopathy is an injury to the tendon that attaches the calf muscle to the bones on the inside of the foot.

Tendonitis
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Causes

Causes of posterior tibial tendinopathy include:

  • Overuse of the tendon
  • Abnormal body mechanics, such as rotating the foot inward too much when walking
  • Trauma

Risk Factors

This problem is more common in women who are over 40 years of age, especially those who are obese. Other things that may raise the risk are:

  • Loose ligaments
  • High blood pressure
  • Diabetes
  • Steroid use
  • Previous surgery or foot trauma

Risk factors in athletes may be:

  • Over-training
  • Wearing the wrong sports shoes

Symptoms

Problems may be:

  • Pain and swelling on the inside of the foot and ankle
  • Pain that increases with activity, such as with running or walking
  • Pain on the outside of the ankle

These symptoms may cause the arch of the foot to become flat over time.

Diagnosis

The doctor will ask about your symptoms, health history, and the activities that you do. A physical exam will be done. It will focus on the foot. This may be enough information to suspect the diagnosis.

Images of your foot and ankle may be taken to confirm the diagnosis. This can be done with:

Treatment

The goal is to ease pain, improve motion, and stop or slow the problem from getting worse. This may be done with:

  • Ice, rest, and medicine to ease pain and swelling
  • Exercises to stretch and strengthen the muscles around the foot and ankle
  • A brace, cast, or shoe inserts to keep the foot or ankle from moving

Some people may need surgery to repair the tendon when other methods do not help.

Prevention

It may be possible to prevent this problem by getting early medical care to treat any foot deformities.

RESOURCES

The American Orthopaedic Society for Sports Medicine  http://www.sportsmed.org 

OrthoInfo—American Academy of Orthopaedic Surgeons  http://www.orthoinfo.org 

CANADIAN RESOURCES

Canadian Orthopaedic Association  http://www.coa-aco.org 

Canadian Orthopaedic Foundation  http://www.canorth.org 

References

Posterior tibial tendon dysfunction. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00166. Updated September 2017. Accessed March 30, 2020.

Posterior tibialis tendon dysfunction. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/posterior-tibialis-tendon-dysfunction  . Updated June 7, 2016. Accessed March 30, 2020.

Tibialis posterior tendinosis and tibialis posterior tenosynovitis. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/musculoskeletal%5Fand%5Fconnective%5Ftissue%5Fdisorders/foot%5Fand%5Fankle%5Fdisorders/tibialis%5Fposterior%5Ftendinosis%5Fand%5Ftibialis%5Fposterior%5Ftenosynovitis.html. Updated December 2019. Accessed March 30, 2020.

Yao K, Yang TX, et al. Posterior Tibialis Tendon Dysfunction: Overview of Evaluation and Management. Orthopedics. 2015 Jun;38(6):385-391.

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