Posterior Tibial Tendonitis
What is the posterior tibial tendon and why does it occur?
The posterior tibial tendon is a tendon that travels along the inner aspect of the lower leg, eventually coursing around the inner aspect of the ankle and attaching to two small bones of the midfoot region. The tendon functions to plantarflex (i.e. point your foot downwards) and invert (tilting of the sole of the foot towards the body’s midline) the foot. The tendon also helps to support the arch of the foot. Tendonitis usually occurs from overuse and is associated with many activities, especially running, but may also result from trauma, specifically previous ankle fractures. It can also be chronic and is the most common cause of adult-acquired flat feet deformity. Flat feet results in collapse of the arch of the foot, placing even more stress on the chronically inflamed tendon. This anatomic malalignment leads to even more issues with the ankle and foot as the condition becomes chronic. Obesity, diabetes, increased age, corticosteroid use, and systemic inflammatory disorders are all risk factors for developing posterior tibial tendonitis.
Patients most commonly experience medial ankle/foot pain. Pain is characteristically worse after activity and often associated with weakness. Patients may also notice progressive flattening of their feet.
An x-ray is typically ordered to rule out fracture and other bony pathology. An MRI may be ordered to further assess for tendon tears and other soft tissue pathology.
Nonoperative treatment is the first-line treatment and primarily consists of activity modification. Inflammation will only worsen if activities that cause pain are continued. It is therefore extremely important to back down on these activities. Patients who do not modify their activities end up worsening their condition and prolonging their recovery. NSAID medications such as Advil or Aleve (so long as not contraindicated) may be recommended to help decrease inflammation. Icing the affected area may also help decrease inflammation and pain.
Physical therapy along with some form of immobilization outside of therapy for approximately 6 weeks is usually recommended. An lace-up ankle brace is worn in the majority of cases. Custom orthotics are usually recommended in conjunction with an lace-up brace for improved support. Patients will be provided a referral to a Podiatrist to obtain the custom orthotics.
Patients with more severe cases will often be placed into a walking boot for better immobilization and protection. Patients may need to remain in a walking boot for 3-4 months.
Surgery is usually considered for cases that have failed nonoperative treatment. Surgical management involves debriding the tendon, and repairing or reconstructing a torn tendon.
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After surgery, patients are typically placed into a cam boot for up to 4 weeks, and then transitioned into a lace up brace, followed by physical therapy. Full recovery typically occurs about 3 months after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.