What is Post-Tib Tendonitis?
Post-Tib Tendonitis is also referred to as post tibial tendonitis or posterior tib tendonitis. This condition of the foot involves damage or injury to the posterior tibial tendon. This tendon in the one that runs along the foot and the inside of the ankle. In most cases, damage or injury to this tendon is a result of the tendon being put under too much strain for too long a period of time.
In a normal foot, this tendon serves the function of holding the arch up. When the tendon fails, it can lead to the condition of flat footedness. Should this occur, it is far more than a cosmetic issue. Flat footedness in turn can lead to heel pain, arch pain, plantar fasciitis, and even painful bony hell spurs.
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What Causes Post-Tib Tendonitis?
The number one cause of problems with the posterior tibial tendon is overuse of the tendon. Overuse leads to strain, which causes inflammation of the tendon. Periods of inflammation may come and go during the initial stages of repetitive strain placed on the tendon, but over time, the repeated bouts of strain will take their toll and the tendon will become permanently damaged.
A less common cause of problems in the posterior tibial tendon is a deformity such as flat feet, which can occur because of inherited genetic factors.
What are the Symptoms of Post-Tib Tendonitis?
Several symptoms may indicate that your foot problem has its roots in an issue related to the posterior tibial tendon. Among these symptoms are all of the following:
- inflammation of the posterior tibial tendon
- pain in the affected foot, most notably in the region of the instep
- rupture of the tendon
- over pronation of the foot, also known as flat footedness
The last two symptoms only occur in very severe cases of post-tib tendonitis. If the condition is caught early so that treatment and prevention measures may be taken, it is not likely that the tendon will become strained to the point where it will rupture.
Diagnosis of Post-Tib Tendonitis
In most cases, your health care professional will only need to conduct a simple physical examination in order to confirm your suspicion that you may have post-tib tendonitis. This is because the symptoms of the condition manifest themselves in a way that is apparent to the naked eye, particularly when the doctor has been trained to recognize conditions that may afflict the feet.
You can expect to sit on the examining table and lift your feet for inspection. To compare foot structures, your health care professional will probably examine both of your feet, even if only one of them is currently experiencing symptoms.
It is not common for MRI (magnetic resonance imaging) scans to be required for a diagnosis of post-tib tendonitis. However, in some cases your health care professional may order one in order to ascertain the exact extent of damage already done to your tendon. If he or she suspects that the tendon has already begun to rupture or tear, an MRI may be ordered to confirm this suspicion and to see just how far the damage has progressed.
Treatment Options for Post-Tib Tendonitis
There are several common treatment options available, though not all treatment options are appropriate in every case. Only your health care professional can state for certain which treatments are best suited to your particular presentation of post-tib tendonitis.
The most common treatments include all of the following:
- orthotic devices such as
- arch support devices
- specially designed footwear
- cushioning inside shoes
- shock absorbers inside shoes
- decreasing activities such as walking, standing, or running
- anti-inflammatory drugs
- adjusting exercise routines to ones appropriate for the condition
The type of treatment that your health care professional recommends will be largely dependent on your particular presentation of post-tib tendonitis. The more severe the condition is when the doctor first diagnoses it, the more aggressive your treatment will need to be.
Treatment: Rest and Medication
One of the very first recommendations is almost always to begin providing the posterior tibial tendon with a great deal more rest than previously. This is to allow the tendon to recover from the strains imposed on it and may be of great use, particularly if the condition has not yet progressed very far. Patients may be advised to stay off their feet entirely for a time, or in lieu of that, to stay off their feet as much as possible. The more severe the case is, the more likely it is that the rest period will be one of longer duration.
In combination with rest, NSAIDS are frequently recommended and / or prescribed. These are non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen sodium. Although all of these are available over the counter, some doctors still prescribe them in order to provide the patient with pills that are of a considerable higher dosage than what is available online or at a standard retail pharmacy. NSAIDs are particularly likely to be recommended when the patient is experiencing high levels of pain or when there is a noticeable level of swelling and / or inflammation in the posterior tibial tendon. NSAIDs help reduce both pain levels and the incidence of swelling and inflammation.
Apart from rest and medication, the most common initial treatment recommendation is orthotic devices to alter the inside of footwear, and / or adjustment to the type of shoes worn themselves. If your health care professional does not think you need extensive rest, this may well be the very first treatment option recommended.
Arch supports and footwear designed to cushion the feet and provide shock absorption are of little use to remediate this condition if they are not work on a regular basis. It is not enough to include these items in your clothing routine only when your post-tib tendonitis is “acting up.” They should be worn on a daily basis. If not, they may have little or no effect in improving your condition and / or making it more manageable.
These devices are treatment options, to be sure, but they also function in a large way as preventative care and should be regarded as such. In many cases, patients who are fully committed to wearing their orthotics and specially designed footwear see huge benefits from the practice. Just this treatment protocol alone can help them attain the goal of living a fully normal lifestyle, and doing so in relative comfort.
Adjustment to exercise routines is another treatment option sometimes recommended. Whether this will be necessary in any particular case will depend on the type of exercise currently being engaged in, as well as the severity of damage already done to the posterior tibial tendon. It is not good for specific foot muscles to be placed under continuous stress, and this can happen in certain types of physical activity.
If your condition is largely a result of the way you have been working out (in other words, if your current exercise routine has significantly contributed to your post-tib tendonitis), then it is likely that your health care professional will recommend changes. A larger variety of different exercises may be advisable as these will help to utilize more foot muscles so that the same ones are not repeatedly put under strain.
Additionally, some kinds of exercises may no longer be appropriate at all. Activities which require extensive amounts of running, for example, may be ruled out by your condition. This should not be a cause for alarm or despair; it is still perfectly possible to experience a high degree of calorie burning, aerobic activity and do so in a way that will not exacerbate the condition of post-tib tendonitis.
Your health care professional can give you detailed and specific recommendations about changes you should make to your current exercise practices. This advice will be more accurate if you are fully open with your doctor about your current workout routines. Expect to discuss the matter in detail when you discuss treatment options for your condition.
Surgery is not a common treatment protocol for post-tib tendonitis. Only truly serious cases of the condition will require any kind of surgery. Since surgery by its very nature can lead to complications such as infections and related problems, it is in the best interests of patients to exhaust all other treatment options before exploring this one. However, in serious cases surgery may be warranted and even unavoidable. Most health insurance plans will pay for surgical procedures related to correcting a post-tib tendonitis condition.
What Happens During Surgery
The basic goal of post-tib tendonitis surgery is to remove the thickened tissue that has grown up around the area surrounding the inflamed, swollen, or ruptured tendon. The body has attempted to deal with the strain to the posterior tibial tendon by growing extra tissue around it to provide cushioning and support, but this very tissue is a major cause of pain and can sometimes even contribute to the likelihood of tendon rupture in the future. Patients who have had this tissue removed experience decreased levels of pain associated with their post-tib tendonitis condition.
In addition to removal of this thickened tissue, surgery may have another goal: if the tendon has already experienced severe enough strain to become ruptured, it may be possible via surgery to repair this damage. A ruptured tendon simply means that the tendon tissue has become torn.
Not all tendon ruptures are equal. Some tears are very slight; others may be larger and have caused more extensive damage to the tissues of the tendon. In addition, tears vary by age. All this must be taken into account by the surgeon who attempts to repair a ruptured tendon. While it is indeed true that some ruptures can be repaired, it is also unfortunately true that in the majority of cases this is simply not possible. It is especially difficult to repair tendon ruptures that are already old. These have “hardened into stone,” so to speak, and usually cannot be remediated through surgical procedures. The most likely candidate for a tendon rupture repair surgery will have sustained the ruptures in the recent past. Even then, depending on the location and severity of the tear, repairs may not be feasible.
Another Surgical Option: Tendon Grafts
Assuming that a direct repair is simply not possible, another surgical option remains. Sometimes a surgeon can graft tendon tissue onto the injured posterior tibial tendon. This is a more extensive procedure than a simple repair because it has at least two phases:
- exposing the replacement tendons from an alternate location in the patient’s body
- using those replacement tendons to create a graft onto the injured tendon
In some senses then, a graft involves two surgeries.
In most cases, the tendons that are utilized for the graft are those that are located in the four smallest toes of the foot. These tendons usually serve to help flex or bend these toes while walking or standing. After a tendon graft, they will also be able to serve the purposes usually reserved for the posterior tibial tendon.
Fixed flat footedness can result from post-tib tendonitis that has gone neglected for too long. (Additionally, some people are flat footed due to their genetic inheritance). When post-tib tendonitis has caused the condition, a fusion operation known as arthrodesis can alleviate it. In this procedure, some of the joints in the foot are fused together to provide more stability when walking and standing; a side effect of the procedure is a decrease in pain levels.
Several websites provide comprehensive information about the posterior tibial tendon and medical conditions associated with it:
A Patient’s Guide to Posterior Tibial Tendon Problems: This comprehensive site includes animations to help you understand the medical issues.
Posterior Tibial Tendon Rupture: This site includes photographs and x-rays as illustrations.