The tib post tendon is an important tendon when it comes to foot function. Its main role is to support the arch of the foot and aid in plantarflexion and pushing you forward with each step. When it becomes over used it can cause a huge amount of pain and ignoring problems with this tendon over a prolonged period can often result in a tendon dysfunction and lowering of the arch of the foot. In some cases this can cause walking difficulty and extreme pain, it can also leave you more susceptible to a tear which will need surgically fixed and is a complex and major surgery.
Anatomy
The muscle originates deep in the posterior leg from both the tibia and fibula and runs down towards the medial side of the ankle where it attaches to the navicular bone at its most prominent attachment, it does have extra slips which attach to all the mid tarsal bones except the cuboid, which is why it is such an important tendon and why it can cause such a wide ranging area of pain when it is irritated.
Signs and Symptoms
A reduction in arch height can be seen when comparing both feet fi it is affecting on one side, swelling can be visible on the inside of the ankle where it runs, pain when walking at the inside of the ankle and struggling to push forward with each step. Standing still for even short periods will often really annoy the area. An inability to go up on your tip toes or be able to jump or land can be another sign that the tib post is sore. Mid foot pain across the top of bottom of the foot can also sometimes be attributed to a tib post tendonitis or dysfunction.
What causes Tibialis Posterior Tendonitis & Dysfunction
Poor foot mechanics, usually a low arch, weak foot muscles, poor footwear, overuse from too much training or doing too much to quick (Think pre season training or a January fitness kick).
Diagnosis
Clinical assessment, palpation and muscle strength testing can all help. Single leg raise test and hop test are specific to this condition and imaging via X-Ray, ultrasound or MRI are all useful to fully assess the area for degenerative changes and rule out a tear. At Happy Feet NI, we offer ultrasound scanning as part of your initial assessment if required, so we can offer a quick an accurate diagnosis as quick as possible to get you on the correct treatment pathway as soon as possible.
Differential diagnosis
Midfoot osteo arthritis
Ankle arthritis
Flexor Hallucius longus tendonitis
Tarsal tunnel syndrome
Plantar fasciitis
Tibialis Posterior Tendonitis & Dysfunction Treatment
Treatment depends on the extent of the problem. Some stretches and strengthening can help resolve a mild tendonitis, but sometimes it will need immobilised in an aircast boot, strapping, footwear changes, orthotics, shockwave therapy, laser therapy, hyaluronic acid injections (Ostenil tendon), steroid injections, Richie brace or similar ankle foot orthotic brace or even surgery. Getting the correct diagnosis and understanding the level of the tendon injury is very important to manage this problem correctly and efficiently. At Happy Feet NI, we offer diagnostic ultrasound during the initial assessment if required or we can arrange an MRI for you if required to fully assess the problem and get you started on the correct treatment pathway.
Surgery
In some cases, surgical management is required to fully fix this condition. At Happy Feet NI, we can arrange onward referral to a consultant orthopaedic team if needed.