Posterior Tibial Tendon Problems

How Arch Supports Can Prevent the Need for Surgery

Guest Blog by Kate Sheehy of Richmond Physiotherapy

In this guest blog, Kate Sheehy of Richmond Physiotherapy looks at one of the most common foot problems, posterior tibial tendon dysfunction and explains how treatment including the use of arch supports/orthotics can help minimise pain and prevent the need for surgery.

The tibialis posterior is a muscle that runs along the back of the shin bone and feeds into a long stringy tendon called the posterior tibial tendon. Tendons attach muscles to bones and the main function of the posterior tibial tendon is to lift up the arch and support the foot when walking. It acts like a pulley, tucking in behind the inside of the ankle and knitting onto the bones of the instep. When the muscle contracts the tendon pulls up and creates tension along the instep.

Muscles and tendons respond to demand but like all dynamic structures they can become weak if under-used and wearing supportive footwear means the tibialis posterior doesn’t have to work too hard.

But switching from supportive footwear to flimsy summer sandals can create a sudden and substantial change in the workload, sometimes the tendon will not respond adequately and there may be pain and tenderness around the ankle or foot.

For more athletic types, ‘overloading’ may trigger an inflammatory response in the tendon. This can be caused by moving from stiff trainers to lightweight or ‘barefoot’ running shoes.

A sudden change in terrain can also lead to injury. A good example is a regular track runner who goes on holiday and runs barefoot along the beach.

Symptoms

Pain may be experienced behind the ankle, along the line of the tendon or at the instep. There may also be tenderness at the instep and even a little swelling, which is noticeable when compared with the other foot.

Often, the symptoms will seem to settle for a few days and then return. This pattern of symptom behaviour will relate to the pattern of activity and usage including weight bearing, walking and running.

Treatment

Initial physiotherapy treatment may involve ice and low-dose, pulsed ultrasound to reduce the local inflammation.

Supportive strapping will often be used to relieve the strain and support the tendon during its recovery.

Well-fitted, supportive footwear worn with custom orthotics can reduce tibialis posterior tendon pain by supporting the instep and the tendon enough to allow the inflammation to resolve. We recommend Foot Solutions for these products.

Prevention

Tibialis posterior tendon problems are often accompanied by secondary calf muscle tightness which can negatively affect ankle and foot joints. So, once the tendon problem is under control it’s important to restore full flexibility and pliability to the soft tissues of the lower leg. This can be achieved by soft tissue massage and a graduated stretching regime to be followed at home.

Strengthening is important in order to prevent recurrence. Your physiotherapist will show you how to strengthen the muscle gradually so that it responds by increasing in power, thus restoring the instep’s natural dynamic support.