Posterior tibial tendonitis causes pain on the inside of the ankle. Generally, treatment consists of exercises, orthotics, and injections. So, how long does this condition take to heal and do injections help?

Where is the posterior tibial tendon and what does it do?

The posterior tibial tendon attaches the muscles of the back of the calf to the foot. The tendon forms above the ankle and passes behind the bone on the inside of the ankle. It attaches directly onto the inside of the foot close to the medial arch.

In general, the tendon provides support to the arch and the inside of the ankle.

posterior tibial tendonitis

Posterior tibial tendonitis symptoms

The inside of my ankle hurts

Usually, tendon problems occur at the level of the inside ankle bone (medial malleolus). In general, this area is prone to tendonitis because of compression of the tendon and poor blood supply.

Generally, people with tendonitis have pain on the inside of the ankle and weakness of the foot. As the tendonitis gets worse, the arch flattens causing more pain. If this process is not stopped, then the ligaments on the inside of the ankle stretch (spring ligament), and the joints become malaligned. Eventually, ankle arthritis forms.

Usually, there is swelling and tenderness on the inside of the ankle. Also, turning the ankle inwards is weak, and standing on toes is difficult.

Often, we use ultrasound or MRI to see tendon swelling. Sometimes, in more severe cases, we see tears in the tendon. In general, these tears are more painful.

Navicular stress fracture or posterior tibial tendonitis

Sometimes, it can be difficult to differentiate these two problems. In general, navicular stress fractures present with pain and tenderness at the front rather than the inside of the ankle. Nevertheless, there is significant overlap in the presentation of both conditions. You should think about a navicular stress fracture in any active person who presents with pain in the mid-foot.

Treatment 

Generally, most cases can be managed with simple treatments such as:

  • Activity modification including rest from sport
  • Anti-inflammatory tablets such as ibuprofen
  • Physiotherapy to strengthen the posterior tibial tendon and the small muscles of the foot. Posterior tibial tendonitis exercises generally strengthen the muscles of the calf and medial ankle flexors. Exercises include calf raises and theraband exercises to strengthen the muscles that move the ankle inwards.
  • Orthotics to support and allow the tendon to heal.

Shoes for posterior tibial tendonitis

Generally, we suggest stability shoes for posterior tibial tendonitis. These shoes provide support to the medial arch reducing the load on the tendon and allowing the tendon to heal.

Nitroglycerine patches for tibialis posterior tendonitis 

Nitroglycerine patches contain a substance called nitric oxide. Recent evidence suggests that nitric oxide patches improve pain in tendinopathy.  Generally, we suggest patches for 2-3 months in combination with exercise therapy.

Injections for posterior tibial tendonitis

Sometimes, we use injections to help with ankle pain and weakness. Traditionally, cortisone injections provide pain relief and reduce swelling. This pain-free window means that people with this condition can work harder with exercise. However, we need to be careful with cortisone because it can cause tearing of the tendon making weakness worse. Recently, some doctors are using hyaluronic acid or  PRP injections for posterior tibial tendonitis especially if the tendon shows signs of a split or tear.

PRP

What about posterior tibial tendon surgery? 

In general, posterior tibial tendon surgery should only be considered if simple treatments have been tried already. Usually, most surgeons consider a combination of a clean-up of the tendon also known as debridement, or reconstruction using another ankle tendon. In advanced cases, realigning the bones of the heel will help to maintain the tendon surgery. Finally, in severe cases associated with a tendon tear and a flat foot, ankle fusion is the only option.

Final word from Sportdoctorlondon

Generally, if you pick up this condition early, it responds well to simple treatments such as posterior tibial tendonitis exercises and orthotics. On occasion, a cortisone injection to help rehab is reasonable if there is no tendon tear. Otherwise, we consider PRP injections for posterior tibial tendonitis.

Other specific foot and ankle conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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