Tibialis Posterior Tendinopathy: Medial Foot and Ankle Pain

Arch and ankle pain can present in many forms. It sometimes coincides with heel pain, it sometimes results from an increase in activity and it sometimes is influenced by recent or steady weight gain. The impact on an individual’s quality of life associated with arch pain can be huge, leaving some unable to work. Due to the insertion, the Tibialis Posterior is commonly misdiagnosed as plantar fascial injury as arch pain is so commonly contributed. Below we take a closer look at the tibialis posterior and the injury which can leave an individual struggling to walk.

The Tibialis Posterior lies deep within the sub-compartment of the posterior lower leg and attaches to the medial aspect of the navicular bone and is known as an inverter of the foot. More so, the tibialis posterior is a used to reduce the speed and amount of pronation during dynamic uses. It is important to understand the multiple functions of a muscle and its insertions to ensure adequate rehabilitation. Tibialis Posterior Tendinopathy has been found to be a degenerative condition rather than an inflammatory condition and will require strengthening as part of its management plan.

Rigid tape has been found to be a more effective intervention in the reduction of pain than elastic tape when offloading the tibialis posterior (Lee, Lee, Hong, Yu, & Kim, 2015). Additionally, home based and clinic based have been found to be equally effective, however, the study did not take into account the benefits of compliance of exercise rehabilitation and only subjective pain reports.

When it comes to managing tibialis posterior tendinopathy, it all comes to down LOAD! In fact, controlling load is probably a more accurate way to address an injury such as this. You want to offload the region to reduce stress, you want the region strengthened to improve tolerance to stress, you want to manage the stress of the compensating regions and you want to modify any activity that may increase the stress in those areas.

–  Offload:           Tape, Orthotics, Footwear
– Rehab:               Extrinsic and Intrinsic Muscles
– Activities:         Modify all unnecessary activities to non-weight bearing
– Therapy:           Soft tissue therapy including massage, needling and mobilisation

• Additional management options are also available in chronic or even unresponsive individuals such as ECSWT, PRP injections and Cortisone injections but these are more invasive measures.

The management of tendinopathies has begun to consolidate the benefits of exercises based training as the cornerstone for treatment over the last eight years or so. A damaged tendon loves controlled load and the continual adjustments to a patient’s rehabilitation is a necessity in developing the best outcomes. Furthermore, the use of custom orthotics to offload the insertion of the tibialis posterior tendon is recommend for the managing and attenuating load through the region. Soft tissue therapy to improve ankle joint range of motion and reduce stressors on compensatory muscles is also best when looking at the patient overall health. Using not only a diverse management structure within your own clinic but a multidisciplinary team in close communication with each other will optimize the patient’s wellbeing.

 Until Next Time

Jackson McCosker
Director/ Chief Editor

References

Bar, R., Brandon, M., Raffert, D., Sturrock, R., Steultjens, M., Turner, D., & Woodburn, J. (2014). Kinematic, Kinetic and Electromyographic Response to Customized Foot Orthothses in Patients with Tibialis Posterior Tenosynovitis, Pes Plano Valgus and Rheumatoid Arthritis. Rheumatology, 123 – 130.

Bek, N., Simsek, I., Erel, S., Yakut, Y., & Uygur, F. (2012). Home-Based General Versus Center-Based Selective Rehabilitation in Patients with Posterior Tibial TendonDysfunction. Acta Orthop Traumatol Turc, 286 – 292.

Lee, S., Lee, D., Hong, J., Yu, J., & Kim, J. (2015). The Effect of Elastic and Non-Elastic Tape on Flat Foot. Indian Journal of Science and Technology, 1 – 5.

Yao, K., Yang, T., & Yew, W. (2015). Posterior Tibialis Tendon Dysfunction: Overview of Evaluation and Management. 385 – 391.