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Posterior tibial tendonitis is the most common cause of medial ankle pain.  There is usually a history of overuse, such as running, excess walking or prolonged weight bearing activities.  The posterior tibial tendon is a vital tendon of the leg as it functions to hold up the arch of the foot to support during walking.  Once damage to this tendon occurs, the arch slowly collapses.  This condition is progressive and typically occurs in women, overweight individuals, individuals over 40 years of age, rheumatoid arthritis sufferers and those with a history of diabetes. Pain typically radiates along the line of the posterior tibial tendon around the back of the medial ankle, to the navicular tuberosity (on the side of the foot) where it attaches. 

 

Causes – Posterior tibial tendonitis is commonly caused by activities irritating and damaging the muscle including:

• Overuse of the structure by active individuals

• Poor foot mechanics placing to much pressure on the medial ankle (flat or rolled in feet)

• Acute injury to the ankle joint

• Poorly fitting or unsupportive shoes

• Lifestyle factors such as obesity and prolonged standing occupations

• Inflammatory conditions such as rheumatoid arthritis

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Symptoms – In people suffering posterior tibial tendon problems, the tendon typically provides less support and stability for the arch of the foot resulting in:

• Lowering of the weight bearing arch (flat foot)

• Pain on the inside of the ankle and sometimes the underside of the foot

• Unsteadiness on the feet due to weakness of the tendon

• Inability to stand on your toes

• Pain that often worsens with prolonged standing or activity

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Diagnosis – A thorough physical examination by your podiatrist along with your history of symptoms is often enough to diagnose.  Occasionally an xray or ultrasound may be requested to further assist. 

Treatment – If caught early, treatment for posterior tibial tendonitis is aggressive but very effective often involving the following:

• Control the pain with rest and ice.  This may involve some non weight bearing activities for a period of time.

• Exercises to strengthen the tendon

• Padding and strapping to stabilise and support the foot for the short term

• Orthotics are often needed to support the foot and prevent recurrence.