Tibialis Posterior Tendinopathy

Shin SplintsThe tibialis posterior muscle originates from the back of the tibia and fibula (lower leg bones), it then travels down along the inside of the lower leg and ankle (behind the inner ankle bone) where it inserts into various bones in the foot via the tibialis posterior tendon.

The tibialis posterior muscle is responsible for moving the foot and ankle towards the midline of the body (inversion) and pointing the foot and ankle down (plantarflexion). It also helps to maintain the normal arch of your foot and is particularly active during weight-bearing activity such as walking and running.

 

What is Tibialis Posterior Tendinopathy

Tibialis posterior tendonopathy is a condition characterized by tissue damage and sometimes swelling of the tibialis posterior tendon, usually following overuse, resulting in pain located at the inner aspect of the lower leg and ankle.

 

Tibialis Posterior

Signs & Symptoms

  • Pain in the region of the inner lower leg and ankle
  • Ache or stiffness that increases with rest following activities including excessive walking or running (especially uphill, on uneven surfaces), jumping, hoping or activities involving repeated change of direction.
  • Pain that warms up with activity (initial stages of the condition)
  • Tenderness on touching the Tibialis posterior tendon
  • Pain with heel raises (going up on the toes)

 

Risk Factors

  • Being overweight
  • Poor foot biomechanics (especially flat feet)
  • Tight calf muscles
  • Joint stiffness in the foot and ankle, hip & knee
  • Inappropriate training loads (training surface, poor recovery or too quick an increase in intensity or duration)

Joint stiffness

  • Inappropriate footwear
  • Following acute ankle trauma, fractures of the ankle or chronic ankle instability

 

Physiotherapy Management

  • RELATIVE rest from aggravating activities (complete rest is actually detrimental to tendon remodelling)
  • Swelling and pain management = ice, massage, dry needling, taping
  • Bracing or taping to offload the tendon
  • Heel raises or wedges to unload the tendon
  • Progressive rehabilitation program including
    • Stretching
    • Strengthening
    • Joint Mobilisation and manipulation
    • Propripcetive exercises
  • Assessment of running technique and implement strategies to improve Running Biomechanics
  • PROGRESSIVE TENDON STRENGTHENING PROGRAM (The Gold Standard Treatment)
  • Structured Running program focusing on appropriate loading principles

 

Adjunctive Treatment Options 

  • Anti-inflammatory advice
  • Orthotics prescribed by our ModPod Podiatrists
  • Imaging (commonly not required in tendon pathology)
  • CSI if a tenosynovitis is present
  • Platelet-Rich-Plasma (PRP) Injection

 

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