Posterior tibial tendonitis is an uncommon problem of the foot. When this tendon is inflamed in posterior tibial tendonitis or if the posterior tibial tendon ruptures, it can cause serious problems. Most commonly, patients with posterior tibial tendonitis complain of pain in the inside of the foot and ankle, and occasionally have problems associated with an unstable gait.
How is posterior tibial tendonitis diagnosed?
Diagnosis of posterior tibial tendonitis is commonly made by physical examination. Patients have tenderness and swelling over the course of the posterior tibial tendon. Usually they have weakness inverting (pointing the toes inward) their foot. Also common in patients with posterior tibial tendonitis is an inability to stand on their toes on the affected side. When the examination is unclear, or if a patient is considering surgery, an MRI may be obtained. The MRI is an effective method to detect ruptures of the tendon, and it can also show inflammatory changes surrounding the tendon.
What is the treatment for posterior tibial tendonitis?
Conservative treatment of posterior tibial tendonitis consists of special inserts for the shoe, walking boots, or even a short leg cast. The goal of these treatments is to rest the posterior tibialis muscle and decrease the inflammation around the posterior tibial tendon. By providing a stiff platform for the foot, these inserts and boots prevent motion between the midfoot and hindfoot. Preventing this motion should decrease the inflammation associated with posterior tibial tendonitis. Casts are more cumbersome, but are probably the safest method to ensure the tendon is rested.
Other treatments for posterior tibial tendonitis include anti-inflammatory medications and activity modification. The medications can help to decrease inflammation of the posterior tibial tendon. Activity modifications will also help control the inflammation around the posterior tibial tendon.
Surgical treatment of posterior tibial tendinitis is controversial and varies depending on the stage of the condition. Some surgeons debride, or "clean up," the tendon in early stages of the condition. Reconstruction of the posterior tibial tendon is sometimes performed. In this procedure, a neighboring tendon, called the flexor digitorum longus, replaces the damaged posterior tibial tendon. This is usually combined with a bony reconstruction as well. Finally, in more advanced cases of posterior tibial tendonitis, when the foot has become rigid, a fusion is the preferred treatment. A specific treatment program must be initiated with each individual patient.
