Posterior Tibial Tendonitis
Posterior Tibial Tendonitis
CAUSES
Posterior tibial tendonitis is most commonly caused from the excess pressure place on the arch of the foot during walking or running and without proper support. Since the arch is one of the foots shock absorbers, if you have an extremely flexible foot there will be more motion in the arch which causes the tendon to over stretch and eventually micro-tear leading to inflammation and subsequent pain with any weight bearing. Other conditions that can lead to posterior tibial tendonitis are talo-tarsal dislocation (flat foot) which has a genetic link from birth. Also an enlarged or accessory navicular where the posterior tibial tendon attachment changes the fulcrum point of the pull of the muscle and will eventually weaken the muscle leading to a collapse of the arch. Any or all of these will lead to pain, swelling, redness and a decrease in the motion of the foot and subsequent decrease in activities.
DIAGNOSIS
Posterior tibial tendonitis can be diagnosed by a hands on evaluation of the foot testing the muscle strength, usually the patient is unable to point their toes forward and inward without pain or raise up on their toes on the affected foot. Also there is pain to palpation along the tendon from the insertion point going up the inside of the ankle and leg. Patients often relate pain on the inside of the arch when trying to stand or walk. X-rays are taken to obtain views of the bone structure to check for fractures, overgrowth of the navicular bone, accessory bones in the tendon or most commonly a flat foot deformity from the displacement of the ankle bone on the heel bone. Diagnostic ultrasound will also be used to check for thickening, change in the color or tearing of the tendon. Finally an mri may be performed to confirm the suspicions of the doctor that there may be a tear and to what degree and location of the damaged tissue.
TREATMENT
Initial treatment consists of rest, ice, compression and elevation which most people have tried before coming to the doctor. Our medical treatment varies depending on the severity of the condition.
Mild tendonitis can be treated using a soft arch support with a compression anklet stocking and anti-inflammatories or steroid injections with a decrease in activities for a few weeks. Laser therapy may also be recommended to help decrease the inflammation and increase the blood flow to the area to heal the tissues.
Moderate to severe tendonitis may require immobilization in a cam walker with an arch support so that the patient is able to continue to bear light weight and recommended amniotic injections to help repair the tendon and decrease the inflammatory process to allow healing along with laser therapy.
Severe tendonitis or tears may require surgical intervention to repair the tendon or remove the hypertrophic or accessory bone that may be causing the tendon to be inflamed.
After a period of 4 -6 months and / or having failed conservative therapy options mentioned above mofas recommends high intensity shock wave therapy (eswt). Eswt can be beneficial is reducing the calcifications in the tendon caused from injury and induce the inflammatory process leading to the reparative process. A decrease in pain is felt within hours to days.
