Post Tib Tendinopathy

PODIATRY NEWS & REVIEW:

By Columnist Andrea Castello – Biomechanical, Sports and Paediatric Podiatrist:

The tibialis posterior is a muscle that originates from the posterior and medial side of the tibia (shin) and travels via its tendon behind the medial malleolus (inside ankle bone) before attaching to a bone on the inside of the foot called the navicular. The tibialis posterior acts primarily to roll the foot out, and also controls the rate at which the foot rolls in when it contacts the ground.

Injuries of this muscle and tendon complex occur in and around the tibialis posterior tendon rather than the muscle itself.  The tendon of tibialis posterior is progressively loaded as the foot makes contact with the ground and the foot rolls inward.  In those people who have very poorly functioning feet resulting in significant amounts of arch collapse, the tendon may be compressed (squashed) between the ground/shoe and the navicular.  Running sports in particular place increased strain and compression on the tendon, which increases the risk of injury.

Factors that Cause Tibialis Injury

Many contributing factors have been identified as playing a role in tibialis posterior tendon injury.  These factors include:

•    Malalignment (poor foot posture).
•    Hypermobility (increased joint movement).
•    Ligamentous Laxity (overly elastic ligaments).
•    Local trauma.
•    Changes in training technique and intensity.
•    Changes in playing surfaces.
•    Systemic illnesses such as Diabetes.
•    Increased BMI.
•    Poor Footwear.

All of these factors may contribute to acute inflammation in the tibialis posterior tendon.

Inflammation of the Tibialis Tendon

If left untreated, the acute inflammation of the tibialis posterior tendon can develop into chronic inflammation.  This inflammation may result in degeneration of the tendon leading to tendinosis (a breaking down of the collagen within the tendon). In some instances, we may see tears occurring in the tendon.  These are called intrasubstance tears.

The onset of symptoms of tibialis posterior tenosynovitis is usually gradual and affects those between 30 and 40 years of age. The pain is typically not debilitating initially but rapidly worsens with prolonged walking or standing.  In the athletic cohort, it can ultimately affect push off and drive.

In the clinic, pain may be reproduced on palpation over the tendon as it courses behind the medial malleolus. Swelling is often present, being most pronounced in the part of the tendon around its insertion on the navicular.  Pain on toe standing or heel walking is positive for a posterior tibialis injury.

Management of Tibialis Tendinopathy

The management of tibialis posterior tendinopathy includes the following:
•    Reduce activity.
•    Non-steroidal anti-inflammatory drugs.
•    Careful attention to training modification. Stretching and warm up are critical in the acute phase of the injury.
•    Strengthening exercises.
•    Functional foot orthotic devices are also necessary to help improve function and influence the collapse of the foot – in effect reducing the load on the tendon.
•    Footwear changes to more supportive options.

Ultimately tibialis posterior tendinopathy can result in significant disability and long-term loss of function, especially if it is left untreated and associated issues arise such as the rupture of the spring ligament.  If unsure, please make contact with your nearest podiatrist and have your foot assessed.

About Our Podiatry News and Review Columnist

Andrea Castello graduated from the University of South Australia in 1999 and has worked in the public and private sectors in both the country and the city. After completing a Masters Degree in Health Services Management in 2006, Andrea decided it was time to put his education to work and start his own practice, which culminated in the inception of AC Podiatry in late 2007. Since then it has grown to include 8 clinics employing 11 podiatrists.

As a podiatrist, Andrea has spent much of his professional career refining his skills with particular attention given to biomechanical, sports and paediatric podiatry. In addition to standard podiatric skills, Andrea has also completed numerous workshops in Dry Needling and Mobilisation. He is a member of Sports Medicine Australia, the Australasian Academy of Podiatric Sports Medicine, a Mentor to final year students and new graduates, and is currently the podiatrist for the Central District Football Club in the South Australian National Football League.

Disclaimer: The information published in this column are based on the author’s own professional and personal knowledge, and opinion. This information and opinion is not intended to be a substitute for professional medical advice, diagnosis or treatment of any manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition and consult a qualified medical professional before beginning any nutritional program or exercise program. Never disregard professional medical advice or delay in seeking it because of something you have read on InShape News.