Tibialis posterior tendinopathy is a very common foot and ankle condition that we see nearly every week here at Fixio Sports Physio Dee Why. The tibialis posterior is an important muscle that attaches from the back of the shin and runs all the way down to the midfoot. The tendon is vital to maintain the arch of the foot when walking and running. If this tendon is overused or torn it can lead to the foot arch collapsing and cause considerable pain. The most common signs and symptoms of tibialis posterior tendinopathy are:
- Pain along the inside part of the foot, ankle or shin (where the tendon lies).
- There can be swelling or redness over the tendon.
- Pain is typically worse with activity, especially high intensity weight bearing activities that place a lot of pressure on maintaining your foot arch e.g. running, jumping and landing activities.
- Other aggravating activities can include: Standing on your toes (lifting heel off the ground), walking on uneven surfaces and pointing your toes inwards
- A history of trauma will be present in almost half the cases e.g. a previous ankle ligament injury.
- In more serious cases patients may develop a limp or altered gait biomechanics.
- In more chronic cases the foot arch continues to collapse leading to flat feet and you may have pain over the outside of their ankle as well.
What causes tibialis posterior tendinopathy?
Like most tendinopathies, tibialis posterior tendinopathy is most often caused by repetitive excessive load beyond a tendon’s capacity to withstand that load, leading to microtrauma of the tendon. As the tendon degenerates it is replaced with ineffective fibrotic tissue and can progressively lose its function of helping to maintain the foot arch. The main risk factors for developing tibialis posterior tendinopathy are:
- Heavier patients, placing more strain on the foot arch.
- Age over 40, have more chance for age related changes in their tendons.
- Gender: it is more common in women.
- Young athletes (continuously impact loading the foot arch).
- An increase in your training load for example doubling your training load in only a week.
- Different activity surfaces and environments e.g. suddenly changing from running on flat grass to hard concrete.
- Patients with diabetes.
- Clients that genetically have more of an anatomical flat foot.
- Previous trauma to the ankle e.g. ankle fractures.
How does physiotherapy help with tibialis posterior tendinopathy?
Physiotherapists are the go-to leading health care professionals for treating this common overuse injury. The first stage of treatment involves actively breaking the cycle of inflammation and pain leading to the area becoming more sensitive. To do this we need to offload the tibialis tendon, the duration of which will depend on the severity of your symptoms and current activity training load. We will also utilise every hands-on physiotherapy treatment at our disposal to help get your pain under control. This can include:
- Ice, applying ice 20 minutes on 20 minutes off especially after any weight bearing activities you need to do.
- Compression: helps to reduce any swelling and promote blood flow out of the lower leg
- Elevation can be helpful in the initial stages of treatment to reduce swelling and offload the tendon.
- Taping/bracing to help activate and support the tibialis tendon.
- Immobilisation: It may be necessary to use a moon boot for 2-6 weeks.
- Soft tissue massage of the tibialis posterior muscle belly as well as the calf and intrinsic foot muscles can help with pain relief.
- Non-steroidal anti-inflammatory and other pain-relieving medications (in conjunction with your G.P.).
- Shoe modifications to help support your foot arch.
Once the pain is under control we will need to restart a period of graded incremental strengthening of the tibialis posterior muscle. This will involve several specific exercises for the tibialis posterior muscle as well as more generalised lower limb strengthening and proprioceptive balance and co-ordination work. We will also work to address and risk factors and biomechanics with running or landing activities to prevent any future recurrences.