POSTERIOR TIBIALIS TENDON DYSFUNCTION

The posterior tibialis tendon runs along the medial (inside) aspect of the ankle and inserts on the midfoot (navicular). This tendon can become painful for many different reasons.  The tendons can become inflamed and swollen which is termed “tendonitis.”  Often, tendonitis is due to overuse or repetitive motion.  However, this can also be due to tendon degeneration. As people age, tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury.  Tears can develop within the tendon. Posterior tibialis tendonitis/tears can often be seen in patients with flat feet.

TREATMENT

Nonsurgical treatment for posterior tibialis tendon problems helps control symptoms. Surgery is usually not considered until it has become impossible to control the symptoms without it.

Nonsurgical Treatment:

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ketoprofen, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation.

Initial treatments may involve resting and protecting the sore tendon. This may require the need to immobilize your foot and lower leg in a short-leg walking boot for two to four weeks.  Also, a firm arch support takes pressure off the tendon. 

Next, physical therapy is used to strengthen the tendon.  The therapist may use heat, ice, and ultrasound treatments to reduce pain and swelling. 

In the foot and ankle, there is a risk that cortisone will cause a tendon to rupture, therefore, I do not recommend injecting cortisone/steroid into the posterior tibialis tendon.

Surgical Treatment:

Surgery is reserved for those patients with pain even after several months of nonsurgical treatment.  Surgical management involves a tendon transfer (to create a “supertendon”) to the posterior tibialis tendon, as well as cutting the bones in the foot to reshape them.  Research has shown that repairing the tendon without reshaping the bones of the foot does not work well.

To find out more information on Posterior Tibialis Tendon Dysfunction, please visit the Orthopaedic connection website of American Academy of Orthopaedic Surgeons.