Tibialis Posterior Tendinopathy
By Laurence Schubert APAM
The tibialis posterior is a muscle that begins just below the back of your knee and runs along the inside your entire shin. It continues down the inner aspect of the heel and attaches to a bone in the arch of the foot.
This muscle primarily works a stabiliser and assists in moving the foot/ankle down and inwards towards the midline of the body. However, its main role is to the support the arch of the foot. Tendinopathy refers to any type of pathology (injury) that affects the tendon or tissues surrounding it.
What are the symptoms?
Pain will proximate along the inside of the foot and ankle (where the tendon lies). This pain will be felt when touching the area and will be exacerbated with movement, associated swelling is also common. Any activity that requires going up on the toes, hopping or running may be painful. As the tibialis posterior supports the arch of the foot, you may notice your foot rolling in during walking or running. As a result, a compressive pain on the outside of the ankle may be present. If the condition reaches a severe level, activities such as running or even walking will be very painful.
What are the causes?
Generally, a sudden increase or change of activity levels will increase the likelihood of developing tendinopathy. For tibialis posterior tendinopathy, repetitive activities such as walking is likely to be the culprit. Biomechanical deficiencies such as poor foot posture when walking increase the strain being placed on the tendon, leading to a disorganisation of collagen fibres within the tendon.
Having muscle weakness or tightness, being overweight and insufficient recovery periods are risk factors to developing this tendinopathy. As well as past injuries that affect the biomechanics of your ankle, e.g. sprained ankle. Runners and walkers are the most commonly affected by this condition.
How can physiotherapy help?
A physiotherapist will assess and diagnose your condition. Your physio will then analyse any contributing factors that are modifiable. This may include altering activity levels (a period of rest may be required), improving strength of certain muscles and improving foot posture. Initial pain relief will be the goal during the early stages of treatment which can be achieved through soft tissue massage, heat, ultrasound, ice, joint mobilisation and stretching. Your physio will discuss the best treatment options available for your individual case. Part of the recovery will include a targeted rehabilitation program which will strengthen your tendon and allow the tendon to sustain greater loads. This will allow you to get back to activity, with a little pain as possible.