Understanding Tibialis Posterior Tendinopathy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on MARCH 6, 2024
Maintaining healthy feet is crucial for an active lifestyle, as they serve as the foundation of our mobility. Among various foot conditions, posterior tibialis tendinopathy (PTT) stands out as a common yet frequently overlooked issue. This condition affects the posterior tibialis tendon, which plays a pivotal role in supporting the arch of the foot and ensuring stability during movement. PTT can lead to pain, swelling, and a progressive flattening of the foot, significantly impacting an individual's ability to walk, run, or participate in daily activities (Kulig et al., 2009; Neville & Houck, 2009). Early recognition and appropriate management of this condition are essential for preserving foot function and preventing further complications.
Posterior Tibialis Tendinopathy
Posterior tibialis tendinopathy (PTT) is a condition characterised by the degeneration and inflammation of the posterior tibialis tendon, a crucial structure in the foot that runs along the inner ankle and attaches to the bones of the midfoot. This tendon plays a vital role in maintaining the arch of the foot and providing stability during walking and other weight-bearing activities (Kulig et al., 2009; Neville & Houck, 2009).
PTT distinguishes itself from other foot problems by its direct impact on the integrity of the foot's arch. As the tendon becomes weakened or damaged, it can lead to a progressive collapse of the arch, resulting in a condition known as adult-acquired flatfoot. This alteration in foot structure can significantly affect walking mechanics, leading to pain, discomfort, and an increased risk of further injury.
The prevalence of posterior tibialis tendinopathy is notably higher in certain populations, particularly in middle-aged and older adults, individuals with obesity, and those with a history of overuse or repetitive activities that strain the foot (Kulig et al., 2009; Neville & Houck, 2009). Additionally, factors such as flat feet, diabetes, and hypertension can increase the risk of developing PTT.
Causes and Risk Factors of Posterior Tibialis Tendinopathy
The root causes of posterior tibialis tendinopathy (PTT) are multifaceted, with overuse being a primary contributor other root causes include:
Repetitive activities that place stress on the tendon, such as running, walking, or jumping, can lead to microtears and degeneration over time.
Biomechanical issues, such as flat feet or an abnormal gait, can also increase the strain on the posterior tibialis tendon, predisposing individuals to PTT.
Inadequate footwear that fails to provide proper support and alignment can exacerbate these biomechanical issues, further increasing the risk of tendon damage (Kulig et al., 2009; Neville & Houck, 2009).
Specific risk factors associated with the development of PTT includes
Age, with a higher prevalence in middle-aged and older adults
Obesity, which places additional stress on the foot and tendon.
Individuals with diabetes or hypertension may also have an increased risk due to the potential impact of these conditions on blood flow and tissue health.
To reduce the risk of developing PTT, it is essential to practise proper foot care and make lifestyle adjustments. This includes:
Wearing supportive footwear, especially during physical activities, and incorporating exercises that strengthen the muscles supporting the foot and ankle.
Maintaining a healthy weight can also alleviate excess stress on the feet.
Regular stretching and conditioning of the lower leg muscles can improve flexibility and reduce the likelihood of overuse injuries.
By being proactive in foot care and lifestyle choices, individuals can significantly decrease their risk of posterior tibialis tendinopathy.
Signs and Symptoms of Posterior Tibialis Tendinopathy
The signs and symptoms of posterior tibialis tendinopathy (PTT) can vary among individuals but commonly include pain and swelling along the inner side of the ankle and foot, particularly in the area of the posterior tibialis tendon. This pain often worsens with activity and may improve with rest. As the condition progresses, individuals may notice a flattening of the arch of the foot, leading to a change in foot shape known as adult-acquired flatfoot. In more advanced cases, there can be a noticeable inward rolling of the ankle (Kulig et al., 2009; Neville & Houck, 2009; Kohls-Gatzoulis et al., 2004).
Early detection of PTT is crucial for effective management and prevention of further complications. It is essential for individuals experiencing symptoms to seek professional guidance from a healthcare provider, such as a physiotherapist or podiatrist, for an accurate diagnosis and appropriate treatment plan.
Case Study Example: A 45-year-old avid runner began experiencing pain along the inner side of her right foot after increasing her weekly mileage. Initially, she attributed the discomfort to overuse and rested for a few days. However, the pain persisted, and she noticed swelling in the area. Upon visiting a physiotherapist, she was diagnosed with posterior tibialis tendinopathy. With a tailored rehabilitation program that included rest, orthotic support, and specific exercises, she gradually returned to running without pain.
Prevention Strategies for Posterior Tibialis Tendinopathy
Preventing posterior tibialis tendinopathy (PTT) involves a combination of
Proper footwear, targeted exercises, and an awareness of gait mechanics. Wearing shoes with adequate arch support and cushioning can help distribute weight evenly and reduce stress on the posterior tibialis tendon. Orthotic inserts may also be beneficial for individuals with flat feet or other biomechanical issues that increase the risk of PTT (Kulig et al., 2009; Neville & Houck, 2009).
Exercises that strengthen the muscles supporting the arch and improve ankle stability are crucial in preventing PTT. Simple exercises like heel raises, toe curls, and arch lifts can be incorporated into a daily routine to enhance foot strength and resilience. Additionally, maintaining flexibility in the calf muscles and Achilles tendon through regular stretching can help prevent excessive strain on the posterior tibialis tendon.
Rest and recovery play a significant role in preventing the onset or progression of PTT. It's important to listen to the body and avoid overloading the feet with excessive or high-impact activities without adequate rest periods. Cross-training with low-impact exercises such as swimming or cycling can help maintain fitness while reducing the risk of overuse injuries.
A holistic approach to foot health involves not only physical measures but also attention to overall well-being. Maintaining a healthy weight, managing chronic conditions like diabetes or hypertension, and staying hydrated are all important factors in preventing PTT and promoting overall foot health (Kulig et al., 2009; Neville & Houck, 2009; Kohls-Gatzoulis et al., 2004; Myerson & Corrigan, 1996).
Treatment Options for Posterior Tibialis Tendinopathy
The treatment of posterior tibialis tendinopathy (PTT) typically begins with conservative measures aimed at reducing pain and inflammation while addressing the underlying biomechanical issues. Rest and activity modification are crucial initial steps to allow the tendon to heal and prevent further damage. Ice and anti-inflammatory medications can help manage pain and swelling in the early stages of the condition.
Orthotics are a cornerstone of conservative treatment for PTT. Keilor Road Physiotherapy can create custom-made arch supports that help redistribute pressure away from the affected tendon and support the foot's arch, reducing strain on the posterior tibialis tendon. In some cases, a more supportive brace or boot may be recommended to immobilise the foot and ankle, allowing the tendon to rest and heal (Kulig et al., 2009; Neville & Houck, 2009).
Physiotherapy plays a central role in the rehabilitation process for PTT. A physiotherapist can design a tailored exercise program to strengthen the muscles supporting the foot and ankle, improve flexibility, and address any biomechanical issues contributing to the condition. Techniques such as manual therapy, ultrasound, and electrical stimulation may also be used to facilitate healing and reduce pain. The goal of physiotherapy is to restore function, prevent recurrence, and enable a return to normal activities (Kulig et al., 2009; Neville & Houck, 2009).
In cases where conservative treatments are unsuccessful, surgical intervention may be considered. Surgical options can range from tendon repair to procedures that address the underlying structural abnormalities contributing to PTT. However, surgery is typically reserved for more advanced cases or when conservative measures have failed to provide relief.
Overall, the benefits of physiotherapy as a conservative and effective treatment option for PTT cannot be overstated. By addressing the underlying biomechanical issues and promoting tendon healing, physiotherapy can help patients regain function and return to their desired activities without the need for invasive procedures.
Physiotherapy's Role in Treating Posterior Tibialis Tendinopathy
Keilor Road Physiotherapy plays a pivotal role in the management and alleviation of posterior tibialis tendinopathy (PTT). By providing a comprehensive approach to treatment, physiotherapists can address the specific biomechanical issues contributing to the condition, promote healing, and prevent recurrence.
Keilor Road Physiotherapy can personalise rehabilitation programs that form a cornerstone of physiotherapy for PTT. These programs are tailored to the individual needs of each patient, taking into account the severity of the condition, the patient's activity level, and any underlying biomechanical abnormalities. Isometric exercises aimed at strengthening the muscles supporting the foot and ankle, improving flexibility, and enhancing proprioception are typically included. Additionally, Keilor Road Physiotherapists use manual therapy techniques to mobilise the affected area and reduce pain, including massage and mobilisation of the ankle joints (Kulig et al., 2009; Neville & Houck, 2009; Kohls-Gatzoulis et al., 2004; Myerson & Corrigan, 1996; Alvarez et al., 2006).
The collaborative approach between patients and physiotherapists is crucial in the treatment and recovery process. Patients play an active role in their rehabilitation, working closely with their physiotherapist to set realistic goals and adhere to their prescribed exercise regimen. Education on proper foot care, activity modification, and strategies to prevent future injuries is also an integral part of the therapeutic process.
Keilor Road Physiotherapy offers a conservative, effective, and holistic approach to treating posterior tibialis tendinopathy. Through personalised rehabilitation programs and a collaborative patient-therapist relationship, we aim to help individuals return to their desired activities with improved function and reduced pain.
Restoring Foot Health with Physiotherapy
Physiotherapy employs a variety of techniques to effectively treat posterior tibialis tendinopathy (PTT), focusing on reducing pain, improving foot function, and enhancing overall quality of life. Stretching exercises are a key component, targeting the calf muscles and Achilles tendon to alleviate tension and reduce strain on the posterior tibialis tendon. Strengthening routines aim to build resilience in the muscles supporting the foot and ankle, particularly the tibialis posterior muscle, to provide better arch support and stability (Kulig et al., 2009; Neville & Houck, 2009).
Gait retraining is another important aspect of physiotherapy for PTT. By analysing and correcting abnormalities in walking patterns, physiotherapists can help distribute weight more evenly across the foot, reducing the risk of further injury. Orthotic devices may be recommended as part of the treatment plan to provide additional support and correct biomechanical issues.
Overall, physiotherapy offers a comprehensive approach to restoring foot health in individuals with posterior tibialis tendinopathy. Through targeted exercises, gait retraining, and the use of supportive devices, physiotherapy can help patients achieve lasting relief and prevent future complications.
Conclusion
This article has highlighted the significance of addressing posterior tibialis tendinopathy (PTT), a common yet often overlooked condition that can impact foot function and overall mobility. Key takeaways include understanding the causes and risk factors of PTT, recognizing the signs and symptoms for early detection, and implementing effective prevention strategies to maintain foot health.
The central role of physiotherapy in treating PTT has been emphasised, showcasing how personalised rehabilitation programs, tailored to address specific biomechanical issues, can lead to successful outcomes. Techniques such as stretching exercises, strengthening routines, and gait retraining have been discussed as crucial components of the physiotherapy approach, demonstrating the potential for reducing pain, improving foot function, and enhancing quality of life.
It is important for individuals experiencing symptoms of PTT to seek professional guidance promptly from the experts here at Keilor Road Physiotherapy. Integrating physiotherapy into the treatment plan can offer a conservative and effective path to recovery, enabling patients to return to their desired activities with confidence.
Taking proactive steps toward managing posterior tibialis tendinopathy with the support of qualified physiotherapists can lead to significant improvements in foot health and overall well-being. Don't let PTT hold you back—seek the expertise of a physiotherapist and embark on your journey to recovery today.
References:
Alvarez, R. G., Marini, A., Schmitt, C., & Saltzman, C. L. (2006). Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot & Ankle International, 27(1), 2-8.
Kohls-Gatzoulis, J., Angel, J. C., Singh, D., Haddad, F., Livingstone, J., & Berry, G. (2004). Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ, 329(7478), 1328-1333.
Kulig, K., Reischl, S. F., Pomrantz, A. B., Burnfield, J. M., Mais-Requejo, S., Thordarson, D. B., & Smith, R. W. (2009). Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomised controlled trial. Physical Therapy, 89(1), 26-37.
Myerson, M. S., & Corrigan, J. (1996). The treatment of posterior tibial tendon dysfunction by the flexor digitorum transfer with calcaneal osteotomy. Foot & Ankle International, 17(9), 563-568.
Neville, C., & Houck, J. (2009). Choosing among 3 ankle-foot orthoses for a patient with stage II posterior tibial tendon dysfunction. Journal of Orthopaedic & Sports Physical Therapy, 39(11), 816-824.
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.