Tibialis Posterior Tendinopathy

  What is tibialis posterior tendinopathy?

The tibialis posterior tendon runs behind the inside of the ankle and helps support the arch of the foot.

If the tendon becomes painful or weak, the arch can gradually flatten in some patients.

What symptoms and signs might I experience?

• Pain behind or below the inside of the ankle.
• Swelling along the tendon.
• Pain when walking.
• Weakness when performing a heel raise.
• Flattening of the arch.
• The heel moving outwards.
• Difficulty walking long distances.
• Pain on the outside of the ankle in more advanced cases.

How is it diagnosed?

Diagnosis involves examination of the tendon and the shape and function of the foot.

Weight-bearing X-rays can assess foot alignment. Ultrasound or MRI may be used to assess the tendon and associated ligaments.

How is it treated without surgery?

Treatment may include:

• Activity modification.
• Physiotherapy.
• Progressive strengthening.
• Supportive footwear.
• Orthotics.
• Bracing or an ankle-foot orthosis.
• Calf stretching where appropriate.
• Weight management where appropriate.
• 
  

When might surgery be considered?

Surgery may be considered when symptoms or deformity continue despite appropriate non-operative treatment.

The operation depends on the stage of the condition and whether the foot remains flexible.

What might surgery involve?

Possible procedures include:

• Tibialis posterior tendon reconstruction.
• Tendon transfer.
• Heel bone osteotomy.
• Achilles or gastrocnemius lengthening.
• Midfoot correction.
• Ligament reconstruction.
• Fusion for a rigid or arthritic deformity.

What is recovery like?

Recovery depends on the extent of reconstruction required.

More complex procedures can require 6 weeks of non weight-bearing followed by a prolonged programme of strengthening and rehabilitation.