Foot Conditions A-Z
Posterior Tibial Tendinitis
Tendons are the strong bands of tissue that connect muscles to bones. Tendinitis is simply inflammation of a tendon, but it can create pain and tenderness near joints. In the feet, the posterior tibial tendon is among the most commonly affected. The posterior tibial tendon is one of the key supporting structures of the foot, helping it to function while walking. It attaches the calf muscles to the bones on the inside of the mid foot and runs down the leg and into the foot just inside the ankle bone.
Note that posterior tibial tendon dysfunction (PTTD) is a separate condition caused by inflammation or damage to the tendon that reduces its ability to support the arch, often resulting in flat feet.
Symptoms of posterior tibial tendinitis may include the following:
- Pain on the inside of the foot and ankle, where the tendon runs (may be associated with swelling in the area).
- Pain that increases with activity. High-intensity/high-impact activities (such as running) can cause this pain; some people may have trouble walking or standing for long periods.
- Pain on the lateral side (outside) of the ankle.
Causes of posterior tibial tendinitis include the following:
- Acute injuries caused by falls and athletic activities that inflame or tear the posterior tibial tendon (people who participate in high-impact activities such as basketball, soccer and tennis are particularly at risk).
- Overuse – over time, the tendon may become inflamed due to activities.
- Obesity, which can lead to excessive strain on the tendon, causing it to become inflamed.
- Degeneration from systemic disorders such as rheumatoid arthritis, diabetes or hypertension can result in inflammation of the posterior tibial tendon.
Prevention and Treatment
To help prevent posterior tibial tendinitis, forego high-impact exercise; instead, do low-impact exercise such as bicycling, elliptical trainer or swimming. To help ensure that your feet are optimally protected during activity, IPFH suggests that you wear only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help protect against injuries to the skin/soft tissue of the foot, due to impact, pressure and shear forces.
Treatment includes rest, cutting back on activities that worsen the pain, icing and anti-inflammatory medication, if tolerated.
For more serious cases, your doctor may prescribe a cast or walking boot, which allows the tendon to rest and the swelling to diminish. Orthotics and braces are often recommended if the condition becomes chronic, and especially if it leads to posterior tibial tendon dysfunction.
More aggressive treatments include physical therapy to help strengthen the tendon; steroid injection (typically not done in the posterior tibial tendon area, and used only as a last resort prior to surgery if less invasive therapy is not effective); or surgery if pain does not decrease after six months of less invasive treatment.
Inflammation of the posterior tibial tendon can lead to posterior tibial tendon dysfunction (PTTD), which results in fallen arches. PTTD can impact the entire musculoskeletal system by changing gait, causing the body to compensate. This compensation often leads to pain and injuries in other parts of the body, including the knees, hips and spine. It is important to seek medical attention for persistent pain in the inside ankle area. Also talk to your doctor if you have soreness, pain, redness, swelling or other indications of foot problems that persist for more than a few days.