Tibialis Posterior Tendinopathy

Tibialis posterior tendinopathy occurs in the tibialis posterior muscle, which runs along the back of the leg and beneath the bony protuberance on the ankle known as the medial malleolus. It is connected to the navicular bone and the 2^nd to 5^th MTs (metatarsals), and is used in foot inversion and plantar flexion (tipping the foot upwards towards the shin). Tendinopathy to this region arises due to degeneration in the tendon, usually associated with overuse in athletes.

Symptoms of Tibialis Posterior Tendinopathy

The inside of the foot will ache and this may extend along the tendon. The pain is likely to be worsened when turning the affected foot both inwards and outwards, and this may make physical activity, even walking, painful to accomplish. Sometimes the tendon makes a creaking sound during movement, known as crepitus. Occasionally you might notice accompanying swelling or redness around the area of the injury.

Causes of Tibialis Posterior Tendinopathy

The condition is primarily linked to overuse of the foot, especially through repetitive outward stretching of the foot and ankle (pronation or eversion). This is common in an event such as speed skating, but can also occur during track events such as when sprinting on tight curves; this motion can force the feet to stretch outwards. Excessive inward rolling of the foot and ankle can also contribute to the injury, and this can be common during running, particularly if you are afflicted with a biomechanical foot problem (e.g. flat feet) or are exercising with fatigued muscles. Typical overuse patterns that can lead to degeneration of the tibialis posterior muscle include a lack of suitable stretching, and training for longer than your level of fitness or strength of muscles can sustain.

Treatment for Tibialis Posterior Tendinopathy

It is important to see a doctor as soon as possible so that they can diagnose the injury and rule out any more serious problems or complications. In the meantime you should rest from all sports and activities involving strenuous use of the injured foot, and begin a course of cold therapy – applying ice to the area a few times per day – in order to relieve pain symptoms. The doctor might prescribe you with anti-inflammatory pain medication such as ibuprofen to further treat the symptoms.

They are unlikely to offer much more in the way of serious treatment because the injury should heal with appropriate rest, but they may well recommend physical therapy to assist with rehabilitation. You can begin to carefully stretch the recovering muscles on your own when you are pain free, though check with a professional. A physical therapist can advise on suitable exercises to stretch and strengthen the damaged area without repeating the injury; this will lead on to a gradual return to full activity.

Prevention of Tibialis Posterior Tendinopathy

Modify your training to fix any overt patterns of overuse, such as unsuitable warm ups or overdoing a sensible amount of exercise. If you need to increase your level of training, always do so incrementally, in small steps, so as to get the muscles used to this new level. If necessary seek appropriate shoe orthotics to correct biomechanical errors that may be interfering with your running or walking technique.