Introduction
The posterior tibial tendon forms the predominant stabilizer of the foot and lower leg. It supports the foot arch and prevents the foot from flattening and compressing. The posterior tibial muscle is present in the back aspect of the shin bone. The posterior tibial tendon is a thick tissue that attaches and supports the bone to the allied muscles. It passes downward in the back of the leg and then under the inner aspect of the ankle. Any injury or stress to the tendon results in a painful, inflammatory, and degenerative condition.
What Is Posterior Tibial Tendonitis?
Posterior tibial tendonitis is also referred to as tibialis posterior tendon dysfunction, acquired adult flatfoot, or tibialis posterior insufficiency. Posterior tibial tendonitis results when the tendons get damaged or torn. The person with posterior tibial tendonitis primarily encounters foot and ankle pain as the tendons are attached to these muscles. Walking, running, and other movements are affected since tendons support the foot arch while doing so.
What Causes Posterior Tibial Tendonitis?
There is no solitary causative agent for posterior tibial tendonitis. Nevertheless, a range of causes can be attributable to the development of the inflammatory and degenerative conditions of the posterior tibial tendon. The causes are as follows.
A. Injury: Posterior tibial tendon can get damaged as a result of trauma, ankle sprain, or minor fracture. A direct crack on the inner ankle would also lead to.
B. Footwear: Footwear does not always be a cause. Nevertheless, certain footwear and shoes would influence the foot arch aid, resulting in tendon stress.
C. Overuse: Recurrent use and overload are regarded as contributing factors in high-impact sports activities such as basketball, athletes, and football.
D. Obesity: Overweight employs excess degrees of stress in the lower extremities and thus posterior tibial tendons, causing injury.
E. Inflammatory Conditions: Gout and rheumatoid arthritis are more likely to increase the risk of developing tendonitis.
F. Modified Biomechanics: Altered foot changes, such as the history of flat feet, can be the causative factor as the forces exerted through tendons.
What Are the Signs and Symptoms of Posterior Tibial Tendonitis?
Posterior tibial tendonitis generally occurs in people over the age of forty. The following are the common signs and symptoms.
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Pain in the inner aspect of the ankle and foot.
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Pain while ankle motions.
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Swelling.
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Reduced mobility and restricted movements.
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Flat foot defect due to affected normal foot arch.
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Stiffness or rigidity of the muscles.
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Unreliable gait.
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Crack sound feelings with the tendon movements.
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Difficulty walking and running.
What Are the Stages of Posterior Tibial Tendonitis?
Posterior tibial tendonitis can get worsen through progression and stages with no treatment. Stretching, injury, inflammation, and degenerative changes over time can cause tendon tears. In untreated case of posterior tibial tendonitis, it indulge in progression through the following four stages.
Stage 1:
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Minor degrees of damage and inflammation of the tendon results from overuse and overstretching.
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Mild pain and swelling concerning the tendons. The person can encounter medial ankle pain during motion.
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No evident foot deformity.
Stage 2:
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Partial tearing is evident in the tendons.
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Symptoms such as foot pain, ankle pain, swelling, and flattened foot are intensified and increased in this stage.
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The person has a hard time standing on tiptoes with the affected side.
Stage 3:
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The tendon is torn further.
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The medial foot arch is lost in this stage, resembling flat feet.
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In addition, a rigid flatfoot deformity is evident where the heel is stiffened.
Stage 4:
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The tendon is completely torn and ruptured in the final stage of progression.
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Permanent and severe foot deformity with the lateral aspect of the ankle joint.
How Is Posterior Tibial Tendonitis Diagnosed?
Medical healthcare professionals aid in thorough physical examination, symptoms evaluation and history assessment for diagnosing the pain and swelling a person is experiencing. First, the doctors examine the swelling and tenderness along the posterior tibial tendons. In addition, the ankle joint and foot arch are examined. Finally, the doctor might recommend Magnetic Resonance Imaging (MRI). MRI shows the presence and degrees of rupture of the tendons. In addition, inflammation in the surrounding aspects of the tendons is evident through MRI scans.
What Are the Treatment Options for Posterior Tibial Tendonitis?
The intervention of posterior tibial tendonitis is aimed at relieving the symptoms while preventing the worsening of the degeneration, inflammation, and tear. The treatment option is solely dependent on the stage of the condition. The treatment can be non-operative and surgical.
A. Medical Management
The medical or non-operative option is generally prescribed for individuals in stage 1 of posterior tibial tendonitis. The doctors might prescribe two or a combination of the following means.
1. Rest: Doctors advise one to take rest for a while, with the avoidance of triggers for pain. In addition, one must avoid strenuous activities and sports that put much force and pressure on the tendons.
2. Ice Therapy: Applying ice packs four to five times a day to the inner aspect of the ankle helps relieve certain degrees of pain and inflammation. One must apply gently for about ten minutes over one episode.
3. Compression Therapy: Compression bandage helps reduce swelling. In addition, wearing it regularly for a few days could aid in supporting the affected ankle.
4. Medication: The doctors could prescribe pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation.
5. Footwear: Supportive footwear and shoes with adequate space are recommended.
6. Orthotics: A range of orthotics are available for posterior tibial tendonitis. Braces, orthoses, and ankle support help amend the foot posture, support the medial arch, stabilize the foot, and reduce the stress through the tendons.
7. Physiotherapy: Physiotherapy rehabilitation is prescribed for the improvement of strength, gait, balance, and the mobility of the tendons. The physiotherapy management involves calf stretches, muscle strengthening, and ankle strengthening exercises.
8. Steroid Injection: Steroid injections are prescribed in rare instances to relieve severe pain and inflammation
9. Ankle Immobilization: Ankle immobilization aids such as boots and casts are advised for a few months. This helps fix the ankle and foot in the right position and decreases the tension on the tendons, promoting healing.
B. Surgical Management
Surgery in posterior tibial tendonitis is advised in stage two, other stages, and where the non-operative treatment fails to manage. The function, pain, and progression are addressed and relieved here. The surgery option is dependent on the degree of tendon damage.
1. Debridement: Inflammatory parts are eliminated in debridement.
2. Osteotomy: Certain parts of the foot bone are cut and shifted with the means to change and attain the normal position.
3. Tendon Transfer: Damaged or ruptured tendons of posterior tibials are removed and replaced with others.
Conclusion
Posterior tibial tendonitis can be due to any cause exposing and degenerating the tendons. The person encounters intense pain with swelling. Foot pain is a more profound concern as the movements of the foot and, thus, the ankle is restricted. Early diagnosis and appropriate management pave the way for alleviating pain as it addresses the underlying determinant, such as injury to the tendons.
