Understanding Posterior Tibialis Tendonitis and the Role of Physical Therapy

September 24, 2024

Posterior tibialis tendonitis (PTT) is a condition that affects the tendon responsible for supporting the arch of the foot. The posterior tibialis tendon, which runs along the inside of the ankle and foot, helps maintain the stability of the arch. When this tendon becomes inflamed or irritated, it can lead to pain, swelling, and weakness in the foot and ankle. If left untreated, it can result in flatfoot deformity, which significantly impacts mobility.

In this blog, we’ll dive deeper into what causes posterior tibialis tendonitis, its symptoms, and how physical therapy can play a crucial role in its treatment and rehabilitation.

Posterior tibialis tendonitis can develop due to overuse, especially in individuals who engage in activities that require repetitive foot movements, such as running, walking, or hiking. Other common causes include:

– Flat feet: Having flat feet puts extra stress on the posterior tibialis tendon, making it more prone to injury.

– Obesity: Excess body weight increases pressure on the tendon, leading to irritation.

– Improper footwear: Wearing shoes that lack adequate support for the foot arch can increase strain on the tendon.

– Trauma or injury: Sudden injuries or impacts to the foot or ankle can lead to tendon damage.

 

Over time, repetitive strain or acute injury to the posterior tibialis tendon can cause micro-tears and inflammation, resulting in pain and dysfunction.

 

Common symptoms of PTT include:

– Pain: Discomfort along the inside of the ankle or the arch of the foot, which may worsen with activity.

– Swelling: Visible swelling along the tendon path.

– Instability: Difficulty maintaining balance, especially when standing on one foot.

– Flattening of the arch: As the condition progresses, the arch may begin to collapse, leading to flatfoot.

 

Early intervention is key to preventing further damage to the tendon and potential complications such as permanent flatfoot deformity.

The Role of Physical Therapy in Treating Posterior Tibialis Tendonitis

Physical therapy is one of the most effective non-surgical treatments for posterior tibialis tendonitis. A well-structured rehabilitation program can reduce pain, improve tendon strength, and restore proper foot and ankle mechanics. Here’s how physical therapy can help:

 

1. Pain Management and Inflammation Reduction

– Modalities: Physical therapists use therapeutic techniques like ice, heat, ultrasound, and electrical stimulation to alleviate pain and reduce inflammation in the affected tendon.

– Manual Therapy: Techniques such as soft tissue massage or myofascial release can be used to improve blood flow, decrease muscle tightness, and promote healing.

 

2. Strengthening the Posterior Tibialis Muscle

The primary goal of physical therapy is to strengthen the posterior tibialis muscle and tendon to support the arch and improve foot stability. Some of the most effective exercises include:

– Toe raises: A simple but effective exercise that strengthens the muscles supporting the arch.

– Resisted ankle inversion: Using resistance bands to work on foot inversion, which targets the posterior tibialis muscle.

– Single-leg balance exercises: Enhancing stability and balance through exercises that improve proprioception and tendon strength.

 

3. Improving Flexibility and Range of Motion

– Stretching exercises: Stretching the calf muscles (gastrocnemius and soleus) helps reduce tension on the tendon and improves ankle flexibility.

– Joint mobilization: Therapists may also focus on restoring the normal range of motion of the ankle and subtalar joints, which can become restricted during tendonitis.

 

4. Correcting Foot Mechanics

Physical therapists assess your gait and identify any issues with foot mechanics that could be contributing to tendonitis. They may recommend:

– Orthotics: Custom orthotic insoles to support the arch and offload pressure from the posterior tibialis tendon.

– Taping or bracing: Taping techniques or braces may also be used to temporarily support the tendon while it heals.

 

5. Gradual Return to Activity

A key component of physical therapy is creating a safe and structured plan for returning to daily activities and sports. The therapist will guide you through progressive strengthening exercises and low-impact activities to help you gradually return to full mobility without risking further injury.

 

Tips for Preventing Posterior Tibialis Tendonitis

Prevention is always better than cure. Here are some ways to reduce the risk of developing PTT:

– Wear supportive footwear: Choose shoes with proper arch support, especially if you have flat feet or engage in high-impact activities.

– Strengthen the feet and ankles: Incorporate exercises that strengthen the muscles around your foot and ankle into your workout routine.

– Maintain a healthy weight: Keeping your weight in a healthy range reduces the strain on your feet and tendons.

– Warm up and stretch: Always warm up before exercising and focus on stretching the calf and foot muscles to prevent excessive strain on the posterior tibialis tendon.

 

 

Posterior tibialis tendonitis can be a painful and debilitating condition, but with the right approach to treatment, recovery is possible. Physical therapy plays a vital role in managing PTT by addressing pain, strengthening the tendon, improving foot mechanics, and helping individuals return to their normal activities. Early intervention and a personalized rehabilitation program are key to preventing long-term complications and ensuring a full recovery.

If you suspect you have posterior tibialis tendonitis, it’s important to seek treatment from a healthcare professional or a physical therapist. The sooner you start addressing the issue, the better your chances of a full and speedy recovery.