Pain on the inside of the foot and/or ankle can be caused by inflammation or tendonitis to the posterior tibial tendon, which is located along the inner side of the ankle and foot. This tendon plays a key role in supporting the arch of the foot and allowing for proper foot movement.
There are numerous causes of posterior tibial tendonitis but this pathology is most commonly caused by flat feet (posterior tibial tendon dysfunction), overuse, trauma/injury to the tendon and finally, as we age the tendon may weaken or become less flexible over time causing inflammation.
Posterior tibial tendonitis has a very distinct presentation that includes pain along the inside of the ankle and foot, swelling around the ankle, difficulty standing on tiptoe or walking long distances, weakness in the arch of the foot, leading to flatfoot symptoms in some cases and tenderness to touch over the posterior tibial tendon.
What to Do About It:
Rest and immobilize! The single most important initial treatment that can be done is to rest and immobilize. Switch to low-impact activities, like swimming or cycling, to avoid exacerbating the condition especially if the tendon is tender and swollen.
Apply ice to the affected area for 15-20 minutes several times a day to reduce swelling and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also help reduce pain and inflammation, but be sure to follow a doctor’s advice on dosage.
Physical Therapy: after getting the inflammation to calm down with rest, immobilization, and NSAIDs, physical therapy is extremely beneficial. Physical therapy allows for strengthening of the tendon as well as working on gait, balance, and posture to prevent recurrence. Additionally, an orthotic can help provide additional support to the arch and help reduce strain on the tendon.
When is surgery recommended…
In cases where conservative treatments for posterior tibial tendonitis fail and the tendon is severely damaged or if the condition has progressed to a more chronic stage, surgery may be considered. Surgical intervention is typically considered a last resort for posterior tibial tendonitis, used only when conservative treatments (like rest, physical therapy, orthotics, etc.) have not been effective.
If you’re considering surgery, it’s important to discuss the different options with your surgeon to determine the best course of action based on the severity of your condition and your overall health. The goal of surgery is to relieve pain, restore function, and improve the alignment and stability of the foot and ankle.
1. Tendon Repair or Debridement
Indication: This is performed when there is partial or complete tendon rupture, or when the tendon has become damaged and is not functioning properly. The procedure can accompany the excision of an accessory navicular with the advancement of the posterior tibial tendon.
2. Tendon Transfer
Indication: If the posterior tibial tendon is severely damaged and cannot be repaired, a tendon transfer from another part of the foot or leg (such as the flexor digitorum longus tendon) can be used to replace the posterior tibial tendon’s function.
3. Osteotomy
Indication: In cases where there is significant misalignment of the bones, an osteotomy might be needed to correct the
deformity caused by the tendon dysfunction (such as a flatfoot deformity).
4. Arthrodesis
Indication: when the joint surfaces have become arthritic, painful and/or immobile then arthrodesis of the affected joints is considered. Joints typically to be fused when associated with posterior tibial tendonitis include talonavicular, subtalar, and naviculocuneiform joint. The ankle joint is sometimes fused when the tendonitis is associated with a Stage IV flatfoot.
Surgical intervention is typically considered when more conservative methods fail, and it’s crucial to consult with a foot and ankle specialist to determine the best approach based on the severity of the condition.
Prevention is the best medicine!
- Proper footwear that provides good arch support can prevent tendonitis.
- Strengthening the muscles of the foot and lower leg, as well as ensuring proper running form, can help.
- Avoid overdoing high-impact activities, and gradually increase the intensity of workouts.
If you’re experiencing symptoms of posterior tibial tendonitis, it’s important to see a specialist to get a proper diagnosis and treatment plan tailored to your needs.