Tibialis Posterior Tendinopathy

Tibialis posterior tendinopathy (TPT) is a prevalent overuse injury that impacts the tibialis posterior tendon, a strong band of tissue extending from the inner lower leg to the inside of the foot. This tendon is crucial in supporting the foot’s arch and facilitating ankle movement, particularly by enabling the foot to move inward (inversion).

Symptoms

The primary symptom of tibialis posterior tendinopathy is pain and swelling, typically occurring on the inner side of the ankle and near the tendon insertion on the inner midfoot. The pain tends to be aggravated by weight-bearing activities, such as walking or running but improves with rest.

Additional symptoms may involve:

• Trouble walking or running on uneven surfaces
• Swelling and tenderness around the ankle
• Weakness in the foot’s arch
• Trouble walking on uneven terrain
• Difficulty standing on the heel, especially when balancing on the affected foot
• A sensation of instability in the ankle

Risk Factors

Tibialis posterior tendinopathy mostly affects middle-aged and older adults especially women. It is also more likely to occur in individuals who engage in activities involving repetitive ankle movements like hiking, running, or ballet. Additionally, those with flat foot deformities are at higher risk, as the condition can sometimes lead to a flattening of the foot arch in severe cases.

Diagnosis

In most cases, we can diagnose tibialis posterior tendinopathy by reviewing medical history, conducting a physical exam, and imaging tests. During the physical examination, we will evaluate tenderness, pain, and swelling near the inner ankle and foot, as well as test strength by resisting specific foot and ankle movements.

We may also use imaging tests such as:

• Ultrasound: This can show a thickened and disorganized form of the tibialis posterior tendon and can also check for fluid collected in the tendon sheath.
• X-ray: Helps rule out conditions, like fractures or bone spurs, that may be contributing to the pain.
• MRI: Offers the most detailed pictures of the soft tissues near the ankle, allowing for assessment of inflammation or damage in and around the tibialis posterior tendon.

Treatment

Treatment for tibialis posterior tendinopathy generally entails conservative approaches, including:

• Rest: Avoiding activities that worsen the symptoms.
• Ice: Apply ice packs on the affected region for 10 to 15 minutes multiple times daily.
• Compression: Using a splint or brace to support the ankle.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Using over-the-counter NSAIDs, including ibuprofen or naproxen, to alleviate pain as well as inflammation.
• Stretching and strengthening exercises: After the pain decreases, exercises to improve flexibility and strengthen the muscles around the ankle can be helpful.
• Podiatry: A formal podiatric evaluation involves assessing the foot both statically (lying or standing) and dynamically (while walking). The podiatrist may recommend orthotics (heel inserts) in order to support the arch, and relieve pressure on the damaged tendon.
• Corticosteroid injections: Injection of corticosteroids into the tibialis posterior tendon sheath can ease inflammation and pain.

Surgery may sometimes be recommended for severe TPT cases that fail to respond to other non-surgical treatments. The procedure involves the removal of the damaged tissue and tendon repair.

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