Posterior Tibial Tendonitis

Dysfunction of the posterior tibial tendon is a fairly common affliction of the foot and ankle, caused by inflammation or tearing of the tendon tissue. The condition can limit the tendon’s ability to provide support and stability to the foot arch, causing the feet to flatten. Posterior tibial tendon dysfunction can be treated without surgery.

Posterior Tibial Tendon Anatomy and Function

The posterior tibial muscle is located at the back of your lower leg, starting just below the knee and continuing into the foot and ankle, where its tendon attaches your calf muscle to the bones on the inside of your foot. Its main function is to provide support to the foot arch when walking or running.

During the loading phase of the gait cycle, the foot arch momentarily flattens or “pronates” to provide shock absorption as the posterior tibial muscle lengthens, setting the foot up for the propulsion phase. The posterior tibial tendon dictates the speed and magnitude of pronation, directly affecting the entire lower kinetic chain. Excessive pronation can cause damage to the posterior tibial tendon from overuse, leading to pain and dysfunction.


Posterior Tibial Tendon Tear Symptoms

Pain at the inside of the foot and ankle, sometimes but not always accompanied by inflammation.

Pain that worsens with physical activity, making high-impact activities like running and jumping nearly unbearable. Walking or standing may also cause pain.

Pain at the outside of the ankle due to displacement of the heel bone as the foot flattens during the gait cycle, placing pressure on the ankle.

Causes of Posterior Tibial Tendon Dysfunction

The tendon of the posterior tibial muscle can become damaged from overuse, usually brought on by repetitive and prolonged walking, running and jumping. Poor gait mechanics can also contribute to posterior tibial tendon strain.

Athletes, runners and fitness enthusiasts may be at higher risk of posterior tibial tendon injury and dysfunction. In non-athletic populations, women and people over age 40 have a higher incidence of posterior tibial tendon dysfunction. Being overweight or obese can increase the risk.


Diagnosis of Posterior Tibial Tendon Dysfunction

A health history and clinical exam followed by a simple calf raise test are common diagnostic tools for confirming posterior tibial tendon dysfunction. Other causes of pain must be ruled out, including ligament strains and sprains and arthritis.

At NYDNR, we use real-time diagnostic ultrasound to view the structures of the foot and ankle in motion, to accurately diagnose posterior tibial tendon dysfunction.

Posterior Tibial Tendonitis Treatment

At NYDNR, we go beyond treating pain to get to the source of tendon dysfunction, so we can correct it and restore healthy function. Some of our treatment methods include:

Gait analysis and retraining:

Faulty gait mechanics can be the root cause of posterior tibial dysfunction. NYDNR features the only motion analysis outpatient lab of its kind in NYC. 3D video motion capture and force plate technologies enable us to identify motor deficiencies throughout the gait cycle and quantify baseline joint angles and forces, so we can correct them.

ESWT (Extracorporeal Shock Wave Therapy):

Non-invasive high frequency shock waves can stimulate cellular repair of the posterior tibial tendon, promoting new cell growth and eliminating pain.

Foot Core Training:

Strengthening the intrinsic foot muscles that provide arch support and stability can reduce force loads placed on the posterior tibial tendon throughout the gait cycle.

The foot pain specialists at NYDNRehab are dedicated to helping you restore healthy foot function, so you can participate in the activities you love, without pain.

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