Posterior Tibial Tendinopathy
Posterior Tibial Tendinopathy is a common cause of ankle and foot pain, not just in runners, but both active and inactive individuals. It will typically present as a vague pain, that is slow and progressive, but will intensify to the point where it will affect your day to day activities.
The Posterior Tibialis is a muscle originates from the posterior aspect of the tibia and fibula (shin bones), and courses diagonally towards the inside ankle bone. At this point the the tendinous portion of the muscle, passes behind the ankle bone and underneath the arch of your foot. It attaches to the foot like a hand to majority of the bones in the mid foot. The role of a healthy posterior tibialis muscles is plantar flexion of the ankle, inversion of the foot and elevating/stabilising your arch . Elevation of the arch locks the bones in your mid foot, so that the midfoot and hindfoot become ‘locked’. This allows the calf muscles to act more efficiently during walking and running.
- Typically pain with follow the course of the tendon as it wraps around the inside ankle bone and underneath the foot
- Pain can range from a vague discomfort to intense ache
- Swelling, redness, and warmth can be present
- Pain is worse first steps in the morning, or after sitting for extended periods of time
- Pain will decrease with activity, but will return once you have stopped
So what causes this injury?
You may feel that Podiatrists spend a lot of time talking about footwear, and that is because it is so important to wear the most appropriate shoe for the activity you are undertaking. The wrong footwear can be the instigating factor for the development of this injury
2. Inefficiencies within your foot mechanics
Over time and distance, our body develops compensations for previous injuries, restrictions in joint mobility/muscle flexibility, poor strength etc. This can lead poor loading patterns, and loss of efficiency. Greater strain is placed on the stabilising, and driving muscles as they have to work harder with each step. Eventually the muscles/tendons are overloaded, leading to injury.
3. Poor strength
Strength is vital to stress shielding, so if a muscle/tendon is not able to deal with the stress placed upon it, it will breakdown/become degenerative. With any overload injury, strength needs to be assessed through the localised area, and surrounding structures. In this case foot/ankle/leg plus lumbopelvic strength/control should all be assessed, to determine if it is a causative factor.
4. Training errors
Undertaking your own training program is absolutely fine, but you need to ensure that you are adhering to the training principles. Unfortunately, you may not be aware of these, and so your training program is putting you at risk of developing an overuse injury.
How do I get back to being active?
Great news! If you are proactive with seeking treatment, then the rehabilitation time is significantly less, compared to resting it and giving it time. Unfortunately, physiologically the posterior tibialis tendon has a low level of vascular supply, which means that is does naturally take longer to heal compared to muscles.
Your chosen Allied Health Professional should focus on identifying and addressing the causative factors, as well as treating the symptoms. This will ensure you have a complete rehabilitation and significantly reduce your risk of the injury recurring.
If you have any specific questions, please feel free to email me on the address below or make an appointment with myself or any of our team members on 1300 937 573