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JarheadChiro
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The Injury
The Tibialis Posterior (Tib Post) tendon can become inflamed, partially torn or ruptured. In the general population injuries to this structure are more common in females and can be associated with overweight individuals. A direct kick to the Tib Post tendon can trigger the condition in soccer players, but Tib Post tendon problems usually occur gradually.
The Tib Post muscle arises from the back of the shin bone, passes down the inside of the ankle as a tendon and inserts into the tarsal bones in the middle of the foot. Together with a couple of other tendons (Flexor Hallucis Longus and Flexor Digitorum Longus) the Tib Post passes just behind the bony prominence (malleolus) on the inside of the ankle and this is often where the problem arises.
The function of the Tib Post muscle is to help the calf muscles push the foot down, as in the 'toe off' phase of walking and running, and also to turn the foot inwards. If a person has a heel that turns out at the bottom (everted rear foot), causing the foot to roll inwards (pronate), then more strain is placed on the Tib Post tendon and it can become prone to injury.
The condition can also occur without postural malalignments, where someone has done a lot of running around tight bends or on a road with a camber. Often this doesn't occur dramatically, but is the result of repeated overuse - with every step that is taken the tendon is overloaded and becomes inflamed. The inside of the ankle becomes painful.
Signs & Symptoms
If the Tib Post tendon and its surrounding sheath become inflamed there is pain on the inside of the ankle during movements, particularly pushing the foot downwards (plantar flexion) and turning the sole of the foot inwards (inversion).
The attachment of the Tib Post tendon into the Navicular bone (where the shoe laces are tied) can become painful to touch, as can the Tib Post tendon itself. This commonly occurs behind the bony lump on the inside of the ankle (the medial malleolus) and is often accompanied by swelling. In some cases this area will produce a creaking sound during movements.
The diagnosis of Tib Post syndrome is usually straightforward for the doctor or chartered physiotherapist. However, the patient sometimes takes a little convincing that their pain is not coming from the medial malleolus itself. The involvement of ankle joint and bony structures can be ruled out with an MRI scan.
Treatment
The Tib Post tendon plays an important role in providing support to the arch on the inside of the foot, and its correct functioning is therefore very important. If a problem with the Tib Post tendon is ignored, and a person carries on with sporting activities, it can lead to a complete rupture of the tendon which has to be surgically repaired. This can have a major effect on foot biomechanics, with the inside arch of the foot losing support and 'collapsing'. It is therefore very important that Tib Post tendon problems receive appropriate early treatment.
In the acute stage, when the problem has just developed, the R.I.C.E protocol should be followed - Rest Ice Compression Elevation (never apply ice directly to the skin) - to combat the inflammatory process within the Tib Post tendon sheath. Non Steroidal Anti Inflammatory Drugs (NSAIDs) prescribed by a doctor can be helpful at this stage. If the problem is new, then two weeks rest is usually sufficient to alleviate the symptoms.
In more longstanding cases, it may be necessary to use an injection of a mixture of corticosteroid and a local anaesthetic, into the tendon sheath to help relieve the symptoms. It is important that this is followed by a period of complete rest and some doctors prefer immobilisation for a period of weeks.
It is not just a case of returning to sport once the person is pain free. Abnormal lower leg mechanics are usually involved in Tib Post tendon problems and these should be addressed. Often the forefoot rolls over (pronates) too much and this forces the Tib Post tendon to overwork. Less often, the ligaments that support the foot on the inner side are dysfunctional, leading to overstrain on the Tib Post tendon. Both of these scenarios can benefit from the use of custom made orthotic insoles, which provide adequate support to offload the Tib Post tendon.
Before returning to sport, it is wise to work through an eccentric strengthening program for Tib Post under the supervision of a Chartered Physiotherapist. This allows the tendon to adapt gradually to the demands of sport.
The Tibialis Posterior (Tib Post) tendon can become inflamed, partially torn or ruptured. In the general population injuries to this structure are more common in females and can be associated with overweight individuals. A direct kick to the Tib Post tendon can trigger the condition in soccer players, but Tib Post tendon problems usually occur gradually.
The Tib Post muscle arises from the back of the shin bone, passes down the inside of the ankle as a tendon and inserts into the tarsal bones in the middle of the foot. Together with a couple of other tendons (Flexor Hallucis Longus and Flexor Digitorum Longus) the Tib Post passes just behind the bony prominence (malleolus) on the inside of the ankle and this is often where the problem arises.
The function of the Tib Post muscle is to help the calf muscles push the foot down, as in the 'toe off' phase of walking and running, and also to turn the foot inwards. If a person has a heel that turns out at the bottom (everted rear foot), causing the foot to roll inwards (pronate), then more strain is placed on the Tib Post tendon and it can become prone to injury.
The condition can also occur without postural malalignments, where someone has done a lot of running around tight bends or on a road with a camber. Often this doesn't occur dramatically, but is the result of repeated overuse - with every step that is taken the tendon is overloaded and becomes inflamed. The inside of the ankle becomes painful.
Signs & Symptoms
If the Tib Post tendon and its surrounding sheath become inflamed there is pain on the inside of the ankle during movements, particularly pushing the foot downwards (plantar flexion) and turning the sole of the foot inwards (inversion).
The attachment of the Tib Post tendon into the Navicular bone (where the shoe laces are tied) can become painful to touch, as can the Tib Post tendon itself. This commonly occurs behind the bony lump on the inside of the ankle (the medial malleolus) and is often accompanied by swelling. In some cases this area will produce a creaking sound during movements.
The diagnosis of Tib Post syndrome is usually straightforward for the doctor or chartered physiotherapist. However, the patient sometimes takes a little convincing that their pain is not coming from the medial malleolus itself. The involvement of ankle joint and bony structures can be ruled out with an MRI scan.
Treatment
The Tib Post tendon plays an important role in providing support to the arch on the inside of the foot, and its correct functioning is therefore very important. If a problem with the Tib Post tendon is ignored, and a person carries on with sporting activities, it can lead to a complete rupture of the tendon which has to be surgically repaired. This can have a major effect on foot biomechanics, with the inside arch of the foot losing support and 'collapsing'. It is therefore very important that Tib Post tendon problems receive appropriate early treatment.
In the acute stage, when the problem has just developed, the R.I.C.E protocol should be followed - Rest Ice Compression Elevation (never apply ice directly to the skin) - to combat the inflammatory process within the Tib Post tendon sheath. Non Steroidal Anti Inflammatory Drugs (NSAIDs) prescribed by a doctor can be helpful at this stage. If the problem is new, then two weeks rest is usually sufficient to alleviate the symptoms.
In more longstanding cases, it may be necessary to use an injection of a mixture of corticosteroid and a local anaesthetic, into the tendon sheath to help relieve the symptoms. It is important that this is followed by a period of complete rest and some doctors prefer immobilisation for a period of weeks.
It is not just a case of returning to sport once the person is pain free. Abnormal lower leg mechanics are usually involved in Tib Post tendon problems and these should be addressed. Often the forefoot rolls over (pronates) too much and this forces the Tib Post tendon to overwork. Less often, the ligaments that support the foot on the inner side are dysfunctional, leading to overstrain on the Tib Post tendon. Both of these scenarios can benefit from the use of custom made orthotic insoles, which provide adequate support to offload the Tib Post tendon.
Before returning to sport, it is wise to work through an eccentric strengthening program for Tib Post under the supervision of a Chartered Physiotherapist. This allows the tendon to adapt gradually to the demands of sport.
