In this article, you will find out everything you need to know about posterior tibial tendonitis and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Are you struggling with inner ankle pain or foot arch issues? Posterior tibial tendonitis might be to blame, leading to discomfort and mobility challenges. Learn about its symptoms, causes, and effective ways to manage this condition before it impacts your daily life. Get the insights you need for timely treatment and recovery here.
Table of Contents
- Key Takeaways
- Understanding Posterior Tibial Tendonitis
- The Anatomy of the Posterior Tibial Tendon
- Identifying the Symptoms
- Risk Factors and Causes
- Nonsurgical Solutions
- Prolotherapy
- Surgical Treatment Options
- Role of Foot and Ankle Surgeons
- Preventing Progression
- Case Studies
- Frequently Asked Questions
- Summary
- Clinic Information & Author Bio
- References
Key Takeaways
- PTTD is a progressive condition that starts with posterior tibial tendon inflammation and can lead to flatfoot deformity and arthritis if not treated in stages I-IV.
- Nonsurgical treatments, including physical therapy and custom orthotics, are crucial for managing PTTD, aiming to improve tendon function and alleviate symptoms.
- Surgical intervention may be needed in advanced PTTD stages when conservative measures fail, with procedures tailored to the severity and conducted by specialized foot and ankle surgeons.
Understanding Posterior Tibial Tendonitis
Posterior Tibial Tendon Dysfunction (PTTD) is essentially a progressive condition that results in the weakening of the posterior tibial tendon, leading to a flatfoot deformity and discomfort, typically in one foot only. The posterior tibial tendon plays a crucial role as it is the primary dynamic support for maintaining the medial longitudinal arch of the foot and enables inversion of the midfoot. Consequently, any issues with this tendon can lead to a compromised medial longitudinal arch, which is often associated with flatfoot.
The progression of PTTD can be outlined through various stages.
- Stage I involves Inflammation without an accompanying deformity.
- In Stage II, there’s either rupture or failure of function about this crucial structure, resulting in flattening out feet.
- At Stage III, patients may experience rigid foot shapes coupled with joint arthritis,
Stage IV sees deterioration at articulating surfaces alongside a tilt involving a talus bone.
As damage worsens within said connective tissue fibers known collectively under “posterior tibia,” resultant complications intensify potentially culminating into full-blown insufficiency pertaining particularly towards same regionally located sinewy formation discussed hereinabove: hence why diagnosing/treating early on proves critical when striving toward halting Unraveling onset initially sparked by initial aforementioned malady per se thus safeguarding structurally affected pedal extremities from experiencing undue strains bearing upon them over time leading ultimately down slippery slope toward degenerative disease states if left unchecked untreated properly accordingly sooner rather than later ideally speaking therapeutically meanwhile keeping vigilant eye peeled regarding indicators signalling possible presence underlying pathological entanglement presently unfolding right beneath our very noses so speak metaphorically figuratively literally altogether assuming you catch drift here basically bottom line then yes?
The Anatomy of the Posterior Tibial Tendon
Before exploring the symptoms, it is essential to understand the structure of the posterior tibial tendon. This tendon originates at the posterolateral area of the tibia and posteromedial part of the fibula and from an interosseous membrane, descending behind and below to wrap around the medial malleolus by the inner ankle side. It primarily attaches itself to the navicular bone’s tubercle and sections of medial cuneiform. Segments are planetary linked with bases between metatarsals two through four and second/third cuneiforms and cuboid bone. The function in foot dynamics also involves participation from the flexor digitorum longus.
The vascularization for this specific tendon stems from arteries named after it—the posterior tibial artery—while motor innervation relies on neural input via a similar nomenclature nerve—the tibial nerve. The vulnerability arises in an area just beyond where it passes by the medial malleolus due to lower blood flow levels, which can result in dysfunction or rupture, ultimately impacting its vital role in arch support within our feet.
Identifying the Symptoms of Posterior Tibial Tendonitis
Symptoms of PTTD typically manifest as discomfort and swelling on the inner aspect of both ankle and foot, which often intensify with physical activity. This increase in symptoms can render actions such as walking or ascending stairs especially painful. As this condition advances, it may result in a collapse of the medial longitudinal arch leading to an acquired flatfoot deformity, plano-valgus deformity, and potentially osteoarthritis within the subtalar joint.
The tendon beneath the inside part of the ankle is where one experiences pain related to PTTD. With progression, this pain might extend across many structures on the medial side of the foot. Tendonitis often contributes to this discomfort due to degeneration from repetitive microtrauma, causing fibrotic tissue replacement that reduces function and stability within the said tendon.
Risk Factors and Causes of Tendonitis in the Posterior Tibial Tendon
Numerous risk factors can substantially elevate the chances of experiencing posterior tibial tendon dysfunction (PTTD). Systemic health issues, including obesity, diabetes, and high blood pressure, are significant contributors. These systemic conditions exert a profound influence on one’s general well-being. Notably, obese middle-aged women have been found to exhibit as much as a 10% prevalence rate for PTTD, highlighting an increased vulnerability within this group. Other factors, such as excessive physical activity, particularly in individuals who engage in high-impact sports, can also lead to the deterioration of posterior tibial tendon function. Age plays a critical role as well, with older adults being more susceptible to tendinopathy due to natural degenerative changes. Furthermore, biomechanical issues, such as flatfoot deformities or abnormal gait patterns, can significantly strain the posterior tibial tendon, further increasing the risk of PTTD.
These are not the sole elements at play regarding risk. Due to its vascular structure, the posterior tibial tendon is especially prone to degenerative ailments that may culminate in tears or impaired tendon functionality. The genesis of PTTD frequently stems from tendinosis attributed to repetitive micro-injuries along with degradation over time. This undermines the structural integrity necessary to sustain foot arch support—the medial longitudinal arch. Despite being influenced by system-wide factors commonly affecting both sides of the body equally, it’s noteworthy that occurrence is typically isolated to one side rather than occurring bilaterally, which remains uncommon.
Nonsurgical Solutions for Posterior Tibial Tendonitis
In managing PTTD, nonsurgical approaches are crucial. These methods encompass medications for pain relief, supportive devices such as custom orthotics and arch supports, proper footwear, sufficient rest, and modification of physical activities. Of these measures, physical therapy and the implementation of personalized orthotic devices to support the arches emerge as critical elements in treatment without surgery.
Physical Therapy and Rehabilitation
- A balance between rest and activity to avoid muscle stiffness and weakening
- Exercises aimed at building strength to increase the tendon’s capacity for stress management
- Targeted exercises including eccentric strengthening (such as lowering the calf from an elevated position) and concentric movements
- Focused workouts for the posterior tibial tendon with appropriate footwear and orthotic support
These regimented activities serve as effective means of treating posterior tibial tendonitis. Stretching routines involving slant board exercises target gastrocnemius and soleus muscles within the calf. These stretches aid in symptom relief while enhancing flexibility. Early incorporation of these practices can elevate mobility levels while decreasing risks related to PTTD recurrence. Thus fostering successful treatment outcomes.
Custom Orthotics and Arch Supports
Incorporating physical therapy with personalized orthotics and arch supports is advantageous for managing PTTD. These tailor-made aids help maintain the medial longitudinal arch by taking on a concave shape at the heel, which boosts stability in the back of the foot and helps to reduce symptoms. To customize these orthotics specifically for patients with PTTD, clinicians employ dynamic measurements of plantar pressure distribution while barefoot to determine each patient’s necessary level of medial arch support.
Such custom-fitted orthotics and supports are highly effective in decreasing strain near the compromised region, promoting tendon recovery and diminishing discomfort experienced by individuals. By bolstering both the inner side and medial arches of feet, these specialized devices ensure that they remain aligned optimally during movement. This alignment assists in symptom relief, facilitating the resumption of regular activities without pain or dysfunction.
Prolotherapy
In recent years, prolotherapy has built its reputation within the medical community due to its clinically proven ability to treat Posterior Tibial Tendonitis.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with small needles. This has been shown to reduce swelling, which helps with Posterior Tibial Tendonitis.
As prolotherapy is helping to treat the root cause of Posterior Tibial Tendonitis, it is deemed to be a permanent fix, preventing the symptoms from returning.
When Surgery Is Necessary: Exploring Surgical Treatment Options
When conservative methods are not effective in stopping the progression of posterior tibial tendon dysfunction, and there’s evidence of tendon and joint degeneration, surgical options may become necessary. The choice of surgical treatment for PTTD depends on how advanced the condition is: Stage II often involves tendon transfers, whereas stages III and IV might necessitate an osteotomy or an arthrodesis.
During the late phases of PTTD, surgeons perform osteotomies to alter bone structure for deformity correction or conduct orthoses, which entails fusing bones within a joint to provide stability. For stage III patients, this may involve triple arthritis. Those at stage IV could require additional fusion procedures involving the ankle joint. Such decisions underscore the essential role that specialists who operate on foot and ankle conditions play when addressing severe cases of posterior tibial tendon dysfunction.
The Role of Foot and Ankle Surgeons in Managing PTTD
- Providing thorough diagnosis
- Creating treatment plans
- Performing extensive physical examinations for those afflicted with PTTD
- Analyzing diagnostic imaging results
- Executing surgical procedures when less invasive options prove inadequate
Foot and ankle surgeons actively participate in expert panels to develop guidelines that influence surgical treatment strategies for conditions such as PTTD based on current research insights and expert consensus. Despite this, successful management of PTTD extends beyond medical procedures to include lifestyle modification.
Preventing Progression: Lifestyle Changes and Home Care Tips
To prevent the advancement of PTTD, a combination of changes in one’s way of life and self-care is essential. Such initiatives can encompass efforts to lose weight and quit smoking since these actions notably alleviate stress on the posterior tibial tendon. Steering clear of foot-straining activities is critical during the initial phase of PTTD to thwart inflammation associated with tendonitis.
Integrating judicious loading into recuperative practices is also pivotal for enduring recovery. This strategy should be augmented by regular utilization of supportive orthotic devices along with soliciting cooperation from employers regarding workplace evaluations or modifications that facilitate effective management strategies for posterior tibial tendonitis.
Case Studies
Case Study 1: Recreational Runner with Stage I PTTD
Patient: 42-year-old female recreational runner presenting with mild medial ankle pain and swelling. Diagnosed with Stage I posterior tibial tendonitis. Initial treatment included rest, NSAIDs, physical therapy focusing on eccentric strengthening, and custom orthotics. Within 6 weeks, the patient reported significant pain reduction and resumed running at a controlled pace.
Case Study 2: Office Worker with Stage II PTTD
Patient: 55-year-old male office worker with collapsed medial arch and difficulty standing on tiptoe. Stage II PTTD confirmed via MRI and single-leg heel rise test. Treatment involved prolotherapy sessions, orthotic intervention, and structured physiotherapy. At 3-month follow-up, the patient regained mobility, and pain levels decreased markedly.
Case Study 3: Athlete with Advanced Stage III PTTD
Patient: 38-year-old competitive footballer presenting with rigid flatfoot and subtalar arthritis. Stage III PTTD confirmed. Combined surgical treatment with osteotomy and tendon transfer was performed, followed by intensive rehabilitation. After 6 months, patient returned to light training and reported significant functional improvement.
Frequently Asked Questions
How long does it take for posterior tibial tendonitis to heal?
It takes 6-8 weeks for improvement from posterior tibial tendonitis, and initiating activities too soon can delay the healing process. Failure to adhere strictly to the prescribed treatment plan may prolong recovery time by double. Thus, diligent compliance is crucial.
What does posterior tibial tendonitis feel like?
Pain surrounding the inner part of the ankle and lower leg, mainly when pressure is exerted, may indicate posterior tibial tendonitis. This condition can also lead to slight weakness during a single-leg heel raise exercise.
How do you get rid of posterior tibial tendonitis?
To alleviate posterior tibial tendonitis, it is recommended that you reduce activities which put strain on the ankle. Utilizing ice therapy, elevating the affected foot, taking over-the-counter pain relievers and engaging in physical therapy can all aid in strengthening the tendon and fostering recovery.
Is it OK to walk with posterior tibial tendonitis?
In the initial phases of posterior tibial tendonitis, walking is permissible. As the condition advances, limiting movement in the affected foot becomes advisable to promote healing of the tendons.
What is Posterior Tibial Tendon Dysfunction (PTTD)?
A gradual weakening of the posterior tibial tendon characterizes Posterior Tibial Tendon Dysfunction (PTTD), which can lead to a flatfoot deformity and associated pain.
Summary
In conclusion, understanding and managing Posterior Tibial Tendon Dysfunction is a journey that begins with knowledge. From understanding its anatomy and symptoms to recognizing the risk factors and embracing both nonsurgical and surgical treatment options, every step is crucial. It’s about making lifestyle changes, adapting, and seeking the proper support from foot and ankle surgeons. With early detection, effective treatment, and a proactive approach, managing PTTD can improve foot health and quality of life.
Clinic Information & Author Bio
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating Posterior Tibial Tendonitis, with patients travelling to see him from across the UK, Europe, and the Middle East. With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with Posterior Tibial Tendonitis and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
Linkedin profile: https://www.linkedin.com/in/oliver-eaton-4338225b/
References
- Kong, A., & Lou, J. (2021). Posterior Tibial Tendon Dysfunction: Clinical Review and Management. Foot & Ankle Clinics, 26(1), 35–50.
- American Academy of Orthopaedic Surgeons. (2022). Management of Posterior Tibial Tendon Dysfunction. AAOS Guidelines.
- Shah, S., & Draganich, L. (2020). Non-Surgical Treatment of Posterior Tibial Tendonitis. Journal of Foot and Ankle Research, 13(45).
- ProHealth Clinic. (2024). Prolotherapy for Posterior Tibial Tendon Dysfunction. https://prohealthclinic.co.uk/pain-and-injury-clinic/
- Johnson, K., & Strom, D. (1989). Tibialis Posterior Tendon Dysfunction. Clinical Orthopaedics and Related Research, 239, 196–206.