“Post-Tib” Tendonitis or “Tib Post” Tendinitis is the term given to any inflammation to the posterior tibial tendon, which runs along the inside of the ankle and attaches to the foot under the medial arch. The posterior tibial tendon can be especially prone to tendonitis, as it helps to maintain the arch of the foot and prevent excessive flattening (over pronation) of the arch while walking, standing or running. This can lead to heel pain, arch pain, plantar fasciitis and/or heel spurs.

What Causes this Condition?

Due to the large amount of force that goes through this tendon, Post-Tib Tendonitis occurs when the muscle is overused and its tendon is strained. As tendonitis is an inflammatory condition, posterior tibial tendonitis is often seen after a sudden increase in activity or exercise, especially if not warmed up properly after an injury. It may also crop up when an old case of posterior tibial tendonopathy is re-injured, and thus becomes re-inflamed.

Further, re-inflammation is possible too, because of the repetitive strain of poor biomechanics, flat feet, or improper shoe wear. Arthritis and normal wear and tear can as well cause some loss of elasticity in the fibers of the tendon, which can give rise to some discomfort during excess physical activity.

Symptoms

Symptoms of posterior tibial tendonitis include pain and swelling along the inside of the ankle and arch, along the course of the tendon. In many cases pain is present when walking, with exercise, or extended periods of standing. If a tear is present in the posterior tibial tendon, or if enough damage is done, pain may be present even at rest.

Pain and swelling are signs of injury to the tendon. In some cases the sheath or sleeve that surrounds the tendon will produce excessive amounts of lubricating fluid, in an attempt to allow the tendon to glide easier during the healing process. It is this excessive fluid production that results in the swelling the patient sees and feels, on the inside of the ankle and arch.

In acute cases, the injury to the tendon that started as tendonitis, may progress to a full or partial tear of the tendon if not rested sufficiently.
If posterior tibial tendonitis does not heal properly, and is not appropriately rehabilitated or treated, the discomfort may increase as the disease progresses.

Stages of Progression

With posterior tibial tendon degeneration and inflammation, the pain and swelling may come and go quickly, but eventually the problem may become more permanent/chronic leading to its dysfunction.  It progresses as follows:

1- Posterior Tibial tendinitis – usually short term after an injury, tear or when the pain in the tendon first occurs.

2- Posterior Tibial tendonosis/tendonopathy – when the tendon pain has been present for some time and the tendon becomes painfully degenerated. At this stage it is often no longer inflamed unless it is re-injured.

3- Posterior Tibial Tendon Dysfunction – when the damage is so severe that there is lengthening and significant degeneration of the tendon.

Treatment

Treatment depends on how long the symptoms have been present and the cause of the tendonitis/tendinosis. Treatment must take into account the cause of the problem and whether or not the tendon is inflamed and or degenerated; how much strength lost or has occurred (if any); and if there are any signs of posterior tibial tendon dysfunction.

Taking these factors into account, treatments could include non-steroidal anti-inflammatory medication, strapping, bandaging, Achilles stretches (if required), rest, icing and orthotics. Custom made orthotics can help to support the arches of the feet, and directly reduce the forces on the tendon to assist with healing. Wearing orthotics may not always be needed, but if worn in your shoes may allow you to resume normal activities. However, care must be taken and you may be advised to reduce all vigorous activities for several weeks, to allow the inflammation and pain to subside, and healing to take place.

If rehab is required, it is usually in later stages, when the tendonitis has progressed past inflammation or if tendinosis (long term degeneration) is present. Physical therapy treatments include ultrasound, soft tissue massage, heat and strengthening exercises. The exercises given to you by your podiatrist help to strengthen the posterior tibial muscle and the small muscles within the feet to help support the arch.

In more severe cases where inflammation or tearing are present, an ultrasound may be ordered or a cast from the knee down may be utilised from four to six weeks to allow the tendon to completely rest, without placing the day-to-day demands of walking on it. If these measures fail to produce acceptable results, surgical intervention may be necessary to clean around the tendon and repair any defects in the tendon. Surgical repair is more commonly needed when there is a progressive weakness and/or lengthening in the tendon and posterior tibial tendon dysfunction occurs.