Tibialis Posterior Tendinopathy

What is it?

Tibialis posterior tendinopathy refers to inflammation within the tibialis posterior tendon, which travels behind the bony bump on the inside of the ankle.

How does it happen?

Tibialis posterior tendinopathy results from overuse and/or overstretching of the tibialis posterior tendon. The function of the tibialis posterior muscle and tendon is to control foot movement and support the arch of the foot. Repetitive use of the tibialis posterior muscle and, therefore, the tibialis posterior tendon can lead to microscopic tears within the substance of the tendon. To repair these microscopic tears, the body commences an inflammatory response. This inflammation with the tendon is part of what makes up a tendinopathy (literally meaning ‘tendon pain’).

How does it feel?

Tibialis posterior tendinopathy results in pain felt behind the bony bump on the inside of the ankle. This pain typically develops gradually. Initially, the tendon may only be painful following exercise. For example, it may be first felt on rising the day following participation. Associated with the pain may be stiffness or tightness in the tendon and ankle. Typically, these initial signs of tibialis posterior tendinopathy are ignored, as they disappear quickly with walking about or applying heat (i.e. a hot shower) over the inside of the ankle. However, as you continue to participate, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. For example, it may begin to be present during participation. In the earlier stages, this pain during participation may initially disappear as you warm-up, only to return when you cool down. However, as you continue to participate, the tendinopathy worsens, and your pain may begin to be present for longer periods during participation until it is present all of the time. This may interfere with your performance.

What should you do?

Tibialis posterior tendinopathy generally does not get better on its own if the cause is not addressed and you continue to exercise. If you have or suspect you have tibialis posterior tendinopathy, you should consult your nearest sports physiotherapist. In the meantime, you can begin initial treatment. This should consist of icing following participation. Icing should consist of applying crushed ice wrapped in a moist towel for 15 – 20 minutes, or ice in a paper cup massaged up and down over the inside of the ankle until the skin is numb.

What shouldn’t you do?

If you have or suspect you have tibialis posterior tendinopathy, you shouldn’t ignore the problem. Your pain may get better as you exercise, however, the exercise you are doing may interfere with the healing process and cause further damage. This can lead to your injury getting worse such that your pain does not ‘warm-up’ and you feel it throughout participation. If this occurs, your recovery may be prolonged, and it may take a number of months for you to return to full activity and sport.

Could there be any long-term effects?

Tibialis posterior tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and appropriately treated. If not, it can lead to prolonged pain in the region behind the bony bump on the inside of the ankle and a prolonged lay-off from participation.

Management

The assistance of a sports physiotherapist is important in the treatment of tibialis posterior tendinopathy. Initially, they can assist in diagnosing the problem and its severity. This may require the use of imaging techniques such as ultrasound or MRI. From this, the sports physiotherapist will be able to determine an appropriate treatment plan. This may involve activity modification, arch support for your feet, soft tissue treatment such as massage and stretching, and the progression through a series of specific strengthening exercises. The sports physiotherapist will also be able to assess and determine why you developed tibialis posterior tendinopathy and address this during your recovery to prevent a re-occurrence when you return to full activity and sport.

Brukner & Khan (2012) Clinical Sports Medicine.