Tibialis posterior dysfunction is one of the most common overuse injuries found in the foot & ankle.
The tibialis posterior muscle originates high in the shin from the back surfaces of the tibia and fibula. It tracks down along the inside border of the tibia, passes around the inside of the ankle and terminates via two attachments in the foot. The main insertion (and that of interest to this particular injury) is into the tuberosity of the navicular.
The tibialis posterior is an extremely important stabiliser of the foot & ankle. It functions to produce inversion at the ankle and also plays a major role in maintaining and supporting the medial arch.
Tibialis posterior tendonitis occurs when there is excessive strain put upon the tendon as it inserts into the navicular.
- As an overuse injury through years of wear and tear associated with high impact activities such as running
- Acutely as a result of sudden increase in training volume or intensity OR the use of inappropriate footwear
Athletes with poor foot biomechanics such as flat or pronated feet, tight calves and poor pelvic stability are at more risk of developing tibialis posterior dysfunction.
Signs & Symptoms:
- Pain: felt along the inside of the foot
- In acute cases there can be visible swelling on inside of the foot
- Pain aggravated by high impact activities such as running & jumping
- Crepitus may be felt along the length of the tendon.
A thorough physical examination by a physiotherapist will usually be sufficient to diagnose tibialis posterior tendonitis. In cases where diagnosis is in doubt an MRI may be required to rule out other potential pathologies.
Initial treatment must focus on unloading the tendon and allowing it to rest. In severe cases where simple weight bearing activities are painful a short period in a walking boot may be warranted. Icing and anti-inflammatory medications may also be suggested by your health care provider.
Physiotherapy management can involve:
- Soft tissue massage to tight surrounding muscles, particularly the calf.
- Electrophysical therapy to reduce inflammation & assist with pain relief.
- Dry needling to reduce inflammation
- Taping of the foot to unload the tendon
- Advice regarding orthoses, shoe inserts & appropriate footwear
- Activity modification
- Exercise prescription of appropriate strengthening exercises
In chronic cases or those that have not responded to conservative therapy further intervention may be required. Options can include corticosteroid injections and surgery.
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