The Tibialis Posterior Tendon functions to invert the subtalar joint and is the main dynamic stabilizer of the hind foot against valgus (eversion) forces, in addition to providing stability to the plantar arch. It is the most anterior structure that passes behind the medial malleolus, then divides and sends attachments to the navicular tuberosi the cuboid, cuneiforms, bases of the second to fourth metatarsals and the spring ligament.
Causes
The etiology of tibialis posterior tendinopathy is usually related to an overuse injury rather than an acute traumatic injury.
1. Overuse-often related to:
- Excessive walking, running or jumping
- Excessive subtalar pronation-this increases eccentric tendon loading during supination for toe-off
2. Acute
- Direct trauma-laceration
- Indirect trauma-eversion ankle sprain, ankle fracture
- Acute avulsion fracture
3. Inflammatory conditions
- Tenosynovitis secondary to rheumatoid arthritis, seronegative arthropathies
Chronic tendinopathy is characterized by collagen disarray and interstitial tears, and may eventually lead to tendon rupture.
Clinical features
- Medial ankle pain behind the medial malleolus and extending towards the insertion of the tendon.
- Swelling is very unusual-if present, it suggests substantial tendon injury or an underlying seronegative arthropathy.
- Tenderness along the tendon prominent posterior and inferior to the medial malleolus.
- Crepitus is occasionally present.
- Resisted inversion will elicit pain and relative weakness compared with the contralateralbc side.
- A single heel raise test also viewed from behind will reveal lack of inversion of the hind foot, and if severe the patient may have difficulty performing a heel raise.
Investigations
- MRI or ultrasound may confirm the diagnosis and reveal the extent of tendinosis.
- MRI is the most useful method of imaging tendons around the ankle. It is highly sensitive and specific for the detection of a rupture.
- In cases of suspected inflammatory tenosynovitis, blood tests for serological and inflammatory markers should be performed.
Treatment
- Conservative care consists of controlling pain where needed with ice and prescribing concentric and eccentric tendon loading exercises.
- Experienced clinicians often administer soft tissue therapy to the tibialis posterior muscle and tendon and prescribe a rigid orthosis to control excessive pronation.
- If an inflammatory arthropathy is present, anti-inflammatory medications are indicated.
- If there is tendon rupture, or if conservative management fails to settle the condition, surgery is recommended.
- In the case of tenosynovitis a synovectomy may be performed, while in cases of severe tendinopathy or tendon rupture a reconstruction may be required.
Tibialis posterior tendinopathy is an swelling and/or discomfort of the tibialis rear muscle in the feet. This muscle helps to back up and secure the feet and rearfoot. Accessible Physical Therapy Services is the best Physical Therapy and Rehabilitation Center in Maryland. Call today for quick Appointment: (301) 593-7300
