This is a strain occurring on the posterior tibial tendon. This common problem affects the foot and the ankle when the posterior tibial tendon is torn or inflamed. Consequently, the tendon is unable to provide support and stability to the arch of the foot, leading to flatfoot. Flat feet leads to arch pain, heel pain, heel spurs and plantar fasciitis.
When you are suffering from posterior tibial tendonitis, pain becomes worse when you engage in strenuous activities such as running or walking. It is also known as adult acquired flatfoot, due to its high prevalence among adults. Although it usually affects one foot, some people have had it in both feet. This condition is progressive. Therefore, it will keep getting worse if not attended to once it starts developing.
What Causes Post Tib Tendonitis?
The posterior tibial tendon is one of the vital foot supporting structures. This fibrous tissue begins in the calf muscles, stretching behind the ankle, then attaches to a midfoot bone. That bone is known as the navicular. It is very important in the structure of the arch. The posterior tibial tendon has an important role of securing the navicular in the right position. This in turn holds the arch of the foot in place, while providing support when tension is transferred from the toes to the rest of the foot. When this particular bone loses position due to tendon malfunction, the arch starts to sag, and eventually disappears. This leads to a flatfoot deformity.
Post tib tendonitis can be caused by various factors. Issues with the posterior tibial tendon, tend to occur in stages. During the early stages, there is irritation of the outer tendon covering, known as paratenon. It causes paratendonitis. This leads to inflammation of the tendon. With age, tendons wear down or degenerate, as well as weaken with time. In a degenerated tendon, there is abnormal arrangement of the fibers that make up the tendon. Due to this abnormal arrangement, tendons usually lose their support and structure. Tendons are made of collagen fibers. Think of it as nylon strand, while the collagen strands are the nylon strands that make this rope. Due to degeneration, the individual strands of the tendon become jumbled.
Additionally, some fibers might even break down and the tendon eventually loses strength. As tendons try to heal themselves from wear and tear, there is formation of scar tissue. This scar tissue thickens the tendon. The thickening process continues gradually, to an extent where a knot or nodule is formed within the tendon. This leads to a condition referred to as tendonosis. The area affected by tendonosis, is much weaker as compared to the rest of the tendon. This weakening might eventually lead to rupturing of the tendon. When the ruptured area becomes inflamed, tendonitis occurs. The wear and tear may be cause by various activities that place pressure on the tendons, such as hiking, climbing stairs, biking and walking especially when you are not used to such activities.
A traumatic injury especially from twisted ankles can affect the tendons. This is a common occurrence among athletes involved in sports like hockey, soccer and basketball. Additionally, excessive force exerted on the foot such as running on concrete surfaces or banked roads, can also contribute to the wear and tear of the tendons. Additional contributing factors include being overweight thus stretching the tendon and making it prone to tears and irritation, previous foot surgeries, previous steroid injections and certain pre-existing diseases like diabetes mellitus or rheumatoid arthritis.
Symptoms and Diagnosis
Post Tibial Tendonitis mainly occurs in one foot, although it might affect both in rare cases. Symptoms develop gradually. However, when tendon tearing occurs, symptoms become obvious. Symptoms of this foot condition may involve.
1. Pain around the ankle and the inside of the foot, especially where the tendon is located.
2. Warmth, redness and swelling, along the ankle and the inside of the foot.
3. Feeling pain that tends to gets worse when you are involved in high impact physical activities like running. Some people suffering from this condition also experience pain when walking or standing for long periods.
4. Inward rolling of the foot and ankles.
5. A popping sound accompanied by pain, especially on the inside of the ankle. This occurs when the tendons are suddenly torn during physical exertions.
6. A feeling of tenderness on the midfoot.
7. Gradual development of pain as the arch flattens mostly affecting the inside of the ankles and foot.
8. Development of flatfoot.
During diagnosis, the first step is foot examination. The physician or foot specialist normally checks for swollen posterior tibial tendon. Your physician may also examine your range of motion. This involves moving the foot sideways as well as up and down. If you have problems with lateral motions, chances are high that you are suffering from post tib tendonitis. Your specialist will also examine the shape of the foot. The physician will check whether the heel has shifted outwards and the arch appears collapsed. Additionally, the foot specialist will check the number of toes visible from the rear.
In normal circumstances, you should only see half of the fourth toe, as well as the fifth toe. If you are suffering from this condition, the fourth and fifth toes are all visible. In worse situations, all the toes are visible. You might also be asked to balance on your tiptoes, using the affected leg. If you have this condition, you will not able to achieve this. A simple foot examination can be enough to diagnose this condition. However, some imaging tests may also be conducted to confirm the results. The doctor may also perform X-rays and CT Scans, if they feel you might be suffering from ankle or foot arthritis.
Post Tib Tendonitis Treatment Options
Treatment methods can be surgical or non-surgical. The treatment method applied depends on the extent of the condition. Most patients are able to fully recover, through the use of non-surgical approaches.
Symptoms usually disappear within a few weeks, if appropriate non-surgical treatment is applied. In other situations, pain may last from three to six weeks, even with early treatment. If you had pain for several months, then it may extend from six months and beyond after treatment commences. Some of the non-surgical approaches include:
Reducing or even stopping the activities that are worsening the pain is usually the first step. If you must exercise, then switch to low-impact exercises. Swimming and elliptical machines don’t place a high impact load on the foot. Most patients are also able to tolerate such activities.
Application of ice packs on the affected area at least 4 times a day, lasting for 15 minutes should help to minimize the swelling. Avoid applying ice directly to your skin. When you place ice over the tendon right after completion of an exercise helps in decreasing the inflammation occurring around the tendon.
Non-steroidal Anti-inflammatory Medication
Drugs like naproxen and Ibuprofen minimize inflammation and pain. You should take such medications an hour prior to the exercise. This helps to reduce inflammation around the tendon. However, you need to know that the inflammation will not go away simply by taking these medications. Such drugs are mainly used to alleviate the pain. If thickening has already developed around the tendons, then you might require extensive treatment methods. It is not advisable to take these medications for more than a month.
You can also use a walking boot or a short leg cast for 8 weeks at most. Such supportive footwear allows the tendon to rest while reducing the swelling. A cast should not be worn for long periods since it causes other leg muscles to atrophy or decrease in strength. It should only be used as a last resort, when other conservative treatments are not working.
Most people suffering from this condition can be helped with braces and orthotics. Orthotics are shoe inserts. They are the most common forms of non-surgical treatments of flat foot. A simple orthotic may just be enough for patients with minor foot-shape change. However, if your foot has already undergone severe shape change, then you will definitely require custom orthotics. Custom orthotics tends to be more costly. However, they give the physicians better control when it comes to position of the foot.
Braces are other common non-surgical treatments applied to correct this condition. However, they are only useful when your condition has not extended beyond the moderate phase. Braces are usually worn around the ankles. Patients who are already suffering from severe flat foot will require custom-molded leather braces. It can also help the patient to avoid surgery.
Your doctor may consider injecting you with cortisone. This powerful drug is very effective in reducing inflammation. However, steroid injections into the posterior tibial tendons are not normally carried out. They are avoided because they might contribute to tendon rupture.
Surgical Treatment Methods
Surgery should only be used, if the condition does not improve after 6 months of non-surgical treatments. The surgical process applied depends on the extent of the tendon damage, as well as the location where the post tib tendonitis has occurred. Surgical reconstruction is an extremely complex process, which should only be a last resort. The following are some of the most common surgical procedures used to treat post tib tendonitis.
This procedure is used when the primary problem is tendonitis, occasioned by thickening of tissue surrounding the tendon. The debridement operation is then carried out this thickened tissue. It is done to reduce the symptoms of pain while preventing tendon rupture. It is conducted with the help of a minor incision in the foot’s instep just above the posterior tibial tendon. With the help of the incision, the surgeon can isolate the tendon and then remove the thickened tissue.
Tendons that are regenerated but are not ruptured yet only require a simple repair. During this operation, the surgeon removes the areas of the tendon that are regenerated. If the surgeon feels that the repaired tendon can be ruptured, he or she might proceed to conduct a graft procedure, which helps to strengthen the strength. After the tendon sheath is repaired, the incision is closed using sutures.
A ruptured or badly regenerated tendon might need a tendon graft. In this procedure, another foot tendon, like the one that flexes the smaller toes is used during the process. It is used to replace the posterior tibial tendon.
In situations where fixed flatfoot is present or the case has been neglected, foot fusion may be the only option available. In this operation, a joint connecting two bones is removed. The two bones are then allowed to fuse or grow together. It is commonly used minimize pain from joints that are worn out. Fusion can also be used to re-align bones in situations where the natural normal alignment cannot occur. To control flatfoot deformity, various joints must be joined together.
How can Tendonitis be prevented?
It has been repeatedly said that prevention is better than cure. If you can manage to stay away from this condition, then you will be able to avoid costly surgical procedures. Additionally, your lifestyle will not be affected. Additionally, if you are already developing signs of this problem, these tips can halt further development of this foot problem.
1. Stretching the calf muscles helps to reduce the risk of developing various soft tissue injuries, such as tendonitis. It also helps to strengthen other leg muscles, thus preventing the injuries on the lower limbs.
2. Stretching and warming up before engaging in physical activities. Warming-up helps to supply blood to the muscles and tendons. This keeps them fully nourished, to handle any strenuous activity that may follow.
3. Ensure that your feet are sufficiently protected and cushioned. This can be done with the help of custom orthotics or arch supports, which reduce the stress placed on the posterior tibial tendon. Consult a physician to determine the right footwear for you.
Post tib tendonitis is a foot problem that can be prevented. However, if you are already suffering from the condition, it is always advisable to seek professional medical help as early as possible. This helps to correct the foot problem, thus eliminating the need for invasive procedures. The most important thing is to ensure that you are wearing the correct footwear at all times.