We always tell our patients to maintain an active lifestyle, but sometimes exercise and activity can lead to foot pain. If you’re suffering from discomfort in your ankle or calf after physical activity, there’s a chance that you’re dealing with posterior tibial tendon dysfunction. Today, we take a closer look at what happens if your posterior tibial tendon becomes inflamed or torn, and we share some treatment options.
Posterior Tibial Tendon Pain
Your posterior tibial tendon plays a vital role in providing stability and support for your ankle and foot. The tendon attaches your calf muscle to the bones on the inside of the foot. Posterior tibial tendon dysfunction is a common issue in the foot and ankle. Problems set in when the tendon becomes inflamed or torn, and because the tendon helps provide stability for the arch of your foot, unresolved issues can lead to the development of flat feet.
Dysfunction of the tendon can occur for a number of different reasons. Problems can develop after a fall, after acute trauma, or through overstress or repetitive use. Athletes who participate in high-impact sports like soccer, basketball, soccer and tennis are at greater risk for injuries to the personal tendon.
Symptoms of posterior tibial tendon dysfunction include:
- Pain on the inside of the foot and ankle.
- Swelling on the inside of the foot and ankle.
- Pain that gets worse with activity.
- Difficulty standing or walking for extended periods.
- Pain on the outside of your ankle.
Posterior Tibial Tendon Diagnosis and Treatment
A diagnosis of posterior tibial tendon dysfunction can typically be confirmed by a physical exam. The doctor will look for the above symptoms, as well as for other physical indicators that become apparent while the doctor is manipulating the foot. The doctor may also ask you to perform the “tiptoe test.” Because standing on your tiptoes requires a healthy posterior tibial tendon, the inability to remain balance on one foot on your tiptoes may indicate an issue with the tendon. Your doctor will also examine your ankle flexibility and range of motion to determine the extent of the damage.
If the doctor wants to be absolutely sure about the diagnosis, they may also order an x-ray, an MRI, a CT scan or an ultrasound.
In most cases, posterior tibial tendon dysfunction can be treated with conservative care. Rest, ice, nonsteroidial anti-inflammatory medications and physical therapy may be enough to calm the inflammation, but others need help from assistive devices. Wearing an immobilization brace will allow the tendon to rest and swelling to decrease, and custom orthotics or shoe inserts can also calm the tendon and provide support to the arch.
If a more hands-on approach is needed, your doctor may first attempt a cortisone injection that works as an anti-inflammatory agent. It is not a very common approach, but it may be available depending on your specific symptoms. If pain persists after six months of conservative care, surgery may be your best option. Your doctor can perform a variety of different operations based on your needs.
- Gastrocnemius Recession and Lengthening of the Achilles Tendon (lengthening of the calf muscles).
- Tenosynovectomy (debridement of the tendon).
- Tendon Transfer.
- Osteotomy (Cutting and shifting of bones to recreate “normal” arch).
- Fusion (to reshape the foot).
The vast majority of patients experience positive results from surgery, but it also depends on how much range of motion and flexibility you had before surgery. For more information about posterior tibial tendon dysfunction or to talk to a doctor about your pain, reach out to Dr. Silverman through the contact form below!
Lance Silverman, MD
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