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Ankle Pain: Posterior Tibial Tendonitis 

By Jesse L. Pace, DO

Posterior tibial tendonitis is often characterized by ankle pain, which is most commonly found along the posteromedial aspect of the ankle, behind the bony prominence known as the medial malleolus. The functions of the posterior tibial tendon are to plantarflex the ankle and invert the foot. This tendon also helps maintain the arch of the foot. The posterior tibial tendon allows one to initiate a single leg toe rise from a position of a single leg stance. 

What are the symptoms?

Usually posterior tibial tendonitis is characterized by pain during activity near the medial side of the ankle that radiates to the arch of the foot. Over time the tendon can tear referring the pain to the lateral side (outside) due to the loss of the ability of the foot to maintain the arch causing the fibula (bone on the outer side of the ankle) to abut the calcaneus (heel bone).

What initially causes posterior tibial tendonitis? 

The initial cause is not exactly known, however obesity, overuse, different forms of arthritis and trauma can lead to posterior tibial tendonitis.

How is posterior tibial tendonitis diagnosed? 

Posterior tibial tendonitis is diagnosed by physical exam by a trained physician. Usually pain along the course of the tendon and resistance testing against contraction of the posterior tibial muscle is enough to diagnose this entity. As the problem progresses, X-ray and MRI can be beneficial in assessing the severity of the tendonitis. Routine labs are not beneficial to diagnose posterior tibial tendonitis, but can help to identify other potential causes of ankle pain.

What is the treatment? 

Usually the treatment is conservative including rest from strenuous or precipitating activities.

The following link contains great information on treating tendonitis.

Physical therapy (PT) can also be ordered to strengthen and stretch the muscles and soft tissues around the ankle. Also, certain additional treatments may be administered by PT including orthotics to help alleviate the pain experienced by the patient. In addition, oral non-steroidal anti-inflammatory medications can help alleviate the symptoms.

Failure to respond to months of non-surgical conservative management leaves surgical treatment as an option. The operative procedure depends on the severity of the stage of the disease. Both soft tissue and bony procedures can be performed by an orthopaedic surgeon to treat the problem.

What should a patient do if he/she suspects a diagnosis of posterior tibial tendonitis? 

As with any medical condition, one should consult a physician if he/she is having any of the aforementioned symptoms.

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Jones, DC. Tendon Disorders of the Foot and Ankle. J Am Acad Orthop Surg 1993; 1: 87-94.

Beals TC, Pomeroy GC and Manoli, A. Posterior Tibial Tendon Insufficency: Diagnosis and Treatment. J Am Acad Orthop Surg 1999; 7:112-118.

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