Posterior Tibial Tendonitis: Exercises, Symptoms and Causes

Posterior tibial tendonitis is when the tendon that supports your arch becomes inflamed or damaged and you get pain and can’t walk.

Studies show that posterior tibial tendonitis is most common among individuals aged 40 and older, particularly in those who are overweight or have a history of ankle injuries. Approximately 10% of runners experience this condition, making it essential to recognize the symptoms early.

For this reason, we will explain what Posterior Tibial Tendonitis is, its symptoms, the exercises that can help, and how to prevent further issues.

What is Posterior Tibial Tendon

The posterior tibial tendon connects the calf muscle to the bones that form the inner arch of the foot, it’s what keeps your foot stable and mobile. This tendon wraps around the medial malleolus, a bony prominence on the inner side of the inner ankle bone.

Its job is to support the arch of the foot when you walk or run, to provide stability for all movements.

Its anatomical position and wrapping around the medial malleolus makes the posterior tibial tendon more susceptible to injury. This tendon also helps in standing on toes and inward movement of the foot, so it’s more important in daily activities

Posterior Tibial Tendonitis Symptoms

Early diagnosis of posterior tibial tendonitis symptoms will help you manage the condition. Pain on the inner side of the foot and ankle and swelling will make walking and daily activities difficult.

Let’s get into the early signs and advanced symptoms of this.

Early Signs

Early signs of posterior tibial tendonitis are mild discomfort and tenderness in the area of the tendon. You’ll feel this tenderness when you touch the tendon or when you experience mild discomfort during certain activities. Early diagnosis is key to evaluation and prevention.

Advanced Symptoms

As it gets worse the symptoms become more severe, flattening of the arch of the foot and toes pointing out. Torn or weakened ligaments can lead to misaligned joints and if left untreated can lead to foot deformity and chronic pain.

Advanced symptoms can be:

• More pain and swelling
• Visible flattening of the arch
• Toes pointing out
• Difficulty walking
• Instability
• Flattened Arch

Early treatment will prevent or slow down the progression to adult acquired flatfoot deformity.

Causes

Overuse and repetitive strain are the main causes of posterior tibial tendonitis. High impact activities like running, jumping or dancing can lead to tendon overuse.

A sudden increase in physical activity intensity, duration or frequency can also over load the tendon and increase the risk of injury.

1. Obesity

Carrying extra body weight puts extra stress on the feet and ankles and increases the risk of developing posterior tibial tendonitis. The added pressure can worsen existing condition and makes it harder to manage.

2. Foot Structure and Biomechanics

Foot structure and biomechanics is a major contributor to posterior tibial tendonitis. People with flat feet or fallen arches puts extra stress on the posterior tibial tendon and increases the risk of tendonitis. Those with high arches can also have poor foot mechanics and put extra strain on the tendon.

Overpronation, or excessive inward rolling of the foot is another biomechanical issue that can worsen the condition.

3. Muscle Imbalances

Muscle imbalances especially in the calf and intrinsic foot muscles can contribute to posterior tibial tendonitis. Weakness in these muscles puts extra stress on the posterior tibial muscle.

And tight calf muscles can limit ankle mobility and put more stress on the tendon during activities.

4. Poor Footwear

Poor footwear is a common but often overlooked cause of posterior tibial tendonitis. Shoes without adequate arch support or cushioning contributes to the condition. Worn out shoes lose its structural integrity over time and fails to support the foot and puts more stress on the tendon.

5. Injury or Trauma

Foot and ankle injury or trauma can cause posterior tibial tendonitis. Acute injuries like sprains or strains can damage the posterior tibial tendon and cause inflammation and ankle pain.

Previous ankle or foot injury can also predispose you to tendonitis.

6. Age and Degeneration

As we age our tendons loses elasticity and strength and becomes more prone to injury. Chronic wear and tear on the posterior tibial tendon can lead to degenerative changes and increases the risk of tendonitis. These age related changes is a major risk factor for the condition.

7. Overuse

Repetitive activities, such as running or walking, especially on hard surfaces, can strain the tendon over time.

8. Medical Conditions

Certain medical conditions can also increase the risk of posterior tibial tendonitis. People with diabetes can have changes in foot structure and circulation and are more prone to tendonitis.

Rheumatoid arthritis which causes joint inflammation can affect the foot mechanics and contributes to the condition.

Posterior Tibial Tendonitis Taping

When dealing with posterior tibial tendonitis, taping can provide essential support and relief. By applying tape to your ankle and foot, you help stabilize the posterior tibial tendon, which plays a crucial role in maintaining the arch of your foot and facilitating movement.

Research indicates that up to 10% of runners may experience posterior tibial tendonitis, often resulting from overuse or improper biomechanics. When taping, you’ll want to ensure that the tape is applied from the midfoot up to the lower leg, creating a supportive structure that alleviates strain on the tendon.

Using a combination of elastic and rigid tape can enhance stability while allowing for some flexibility during movement. This method not only helps reduce pain but also aids in the recovery process, enabling you to return to your regular activities more comfortably.

Posterior Tibial Tendonitis Diagnosis

Posterior tibial tendonitis is diagnosed through physical examination and medical history assessment. Doctors will check foot flexibility to assess tendon dysfunction.

Imaging tests like MRI can detect soft tissue issues like tenosynovitis which are not visible on X-rays.

Stages

Posterior tibial tendon dysfunction progresses through 4 stages, each stage indicates increasing damage and changes in the foot structure.

Stage 1 is mild inflammation and discomfort which can be managed with conservative treatment.

Stage 2 is arch collapse but the foot still has some flexibility.

Stage 3 is rigid deformity that hinders normal foot function and

Stage 4 is chronic where the progressive collapsing foot deformity causes the arch to collapse permanently.

Posterior Tibial Tendonitis Treatment

Treatment for posterior tibial tendonitis ranges from rest and physical therapy to orthotics and surgery depending on the severity of the condition.

It’s important to individualize the treatment plan to the person’s needs and stage of the condition.

Non Surgical Treatment

Non surgical treatment is very effective especially in early stages. These includes rest, immobilization with walking boot or short leg cast and physical therapy to strengthen the surrounding muscles.

Moreover, Orthotic inserts provides additional support and improves foot alignment, NSAIDs like aspirin and ibuprofen relieves pain and reduces inflammation.

Surgical Interventions

Severe cases of posterior tibial tendonitis may require surgical interventions like tendon transfer, tenosynovectomy and osteotomy.

Tenosynovectomy is removal of inflamed tissue around the tendon and is best indicated in very mild disease without significant foot shape changes. Osteotomy corrects bone alignment and arthrodesis fuses bones and limits joint movement, especially for patients with stiff foot or arthritis in key joints.

Posterior Tibial Tendonitis Exercises

Here are some effective exercises for posterior tibial tendonitis that can help strengthen the posterior tibial tendon and improve flexibility, reducing pain and promoting recovery:

1. Calf Stretch

• How to Do It:
  1. Stand facing a wall with your hands against it at shoulder height.
  2. Step one foot back, keeping the heel on the ground and the back leg straight.
  3. Bend the front knee and lean toward the wall until you feel a stretch in the calf of the back leg.
  4. Hold for 15-30 seconds, then switch legs.
• Repetitions: 2-3 times per leg.

2. Towel Stretch

• How to Do It:
  1. Sit on the floor with your legs extended in front of you.
  2. Loop a towel around the ball of one foot and gently pull the towel toward you while keeping the knee straight.
  3. Hold the stretch for 15-30 seconds.
  4. Switch to the other foot.
• Repetitions: 2-3 times per leg.

3. Ankle Inversion and Eversion

• How to Do It:
  1. Sit on a chair with your feet flat on the floor.
  2. For inversion, move your foot inward (toward the other foot) against resistance (like a resistance band).
  3. For eversion, move your foot outward (away from the other foot) against resistance.
• Repetitions: 10-15 times for each direction.

4. Heel Raises

• How to Do It:
  1. Stand with your feet shoulder-width apart and slowly rise onto your toes.
  2. Hold for a moment, then lower back down.
• Repetitions: 10-15 times.
• Modification: You can do this exercise on a step, allowing your heels to drop below the step for a greater range of motion.

5. Toe Taps

• How to Do It:
  1. Sit in a chair with your feet flat on the floor.
  2. Keeping your heels on the ground, lift your toes off the ground and tap them back down.
• Repetitions: 10-15 times.

6. Single-Leg Balance

• How to Do It:
  1. Stand on one leg with the other leg lifted slightly off the ground.
  2. Hold this position for 30 seconds to 1 minute, then switch legs.
  • Progression: Try closing your eyes or standing on a cushion for added challenge.

7. Resisted Ankle Dorsiflexion

• How to Do It:
  1. Sit with your legs extended and loop a resistance band around the top of your foot.
  2. Pull the band towards you while flexing your foot (dorsiflexion).
• Repetitions: 10-15 times for each foot.

8. Arch Lifts

• How to Do It:
  1. Stand with your feet flat on the ground.
  2. Without lifting your toes or heels, try to raise your arches by contracting the muscles in your feet.
• Repetitions: Hold for 5-10 seconds, repeating 10 times.

Tips for Exercising with Posterior Tibial Tendonitis

• Always warm up before starting exercises with light activity or dynamic stretches.
• Listen to your body: If you experience pain during any exercise, stop immediately and consult a healthcare professional.
• Gradually increase the intensity and duration of exercises as your strength and flexibility improve.
• Consider working with a physical therapist for personalized guidance and to ensure proper technique.

As you can see, these exercises can help improve the strength and flexibility of the posterior tibial tendon and surrounding muscles, aiding recovery and reducing the risk of future injuries.

How to Prevent Posterior Tibial Tendonitis

Preventing posterior tibial tendonitis requires proper footwear, exercises and lifestyle changes. Supportive shoes with rigid midfoot and rubber soles can reduce tendon strain.

Exercises focusing on tibialis posterior muscle and surrounding muscles can improve foot stability and reduce the risk of tendonitis.

1. Foot Care and Maintenance

Regular foot care and maintenance prevents posterior tibial tendonitis. Check your feet regularly for signs of injury, blisters or abnormalities. Keep your feet moisturized and free from calluses or cracks to reduce injury risk and foot health.

2. Flexibility and Stretching

Regular stretching is essential to prevent posterior tibial tendonitis. Stretching the calf muscles, Achilles tendon and plantar fascia reduces tension on the tendon and foot health.

Add the calf stretch and soleus stretch to your routine.

3. Footwear

Choose the right footwear. Supportive shoes with good arch support and cushioning maintains the arch and prevents tendon strain.

Check and replace worn out shoes regularly so they still provide support and shock absorption.

4. Orthotic Inserts

Orthotic inserts whether custom made or over the counter can provide additional arch support and improves foot alignment. These inserts can distribute weight evenly and reduce the strain on the posterior tibial tendon.

If you have flat feet or high arches, consult a podiatrist for personalized advice for flat foot.

5. Gradual Progression

Gradual progression in physical activity is key to preventing posterior tibial tendonitis. Slowly increase workout intensity, duration and frequency so the body can adapt and strengthen the tendon without overloading it.

6. Cross-Training

Cross-training in your fitness routine reduces the risk of overuse injury. Low impact activities like swimming or cycling maintains fitness level while minimizing tendon stress.

7. Healthy Weight

Maintaining a healthy weight reduces stress on the feet and ankles. Excess body weight adds more pressure on the posterior tibial tendon and increases the risk of tendonitis.

8. Technique

Proper technique during exercises and sports activities minimizes injury risk. Good form and movement pattern protects the posterior tibial tendon from excessive strain.

Get professional advice from a coach or trainer to ensure you’re doing activities correctly and safely.

9. Regular Check-Ups

Schedule regular check-ups with healthcare professionals like physical therapists or foot and ankle surgeon to monitor your foot and ankle health.

Posterior Tibial Tendonitis Brace

My Personal Recommendations for Posterior Tibial Tendonitis Braces

1. Zamst A1-S Ankle Brace

Provides excellent support and stabilization for the ankle and arch.

• Features: Lightweight design for comfortable movement, prevents excessive motion.

2. McDavid 199 Ankle Brace

Combines adjustable straps with a flexible design for customized support.

• Features: Reduces strain on the posterior tibial tendon.

3. Aircast A60 Ankle Brace

Offers high ankle support and stability during various activities.

• Features: Lightweight design ideal for rehabilitation.

4. Bauerfeind Sports Ankle Support

Provides targeted compression and stability to alleviate pain.

• Features: Allows full range of motion during physical activities.

5. Shock Doctor Ultra Heel & Lace Ankle Brace

Features a laced design for customizable fit and extra stability.

• Features: Reduces pain during movement.

6. Mueller Sports Medicine Adjustable Ankle Brace

Affordable option that combines support and comfort.

• Features: Stabilizes the ankle while allowing flexibility.

7. NatraCure Cold Therapy Ankle Brace

Incorporates cold therapy to reduce inflammation and pain.

• Features: Ideal for use after activity.

8. Kneedler Adjustable Ankle Support

Lightweight brace offering moderate support and adjustable fit.

• Features: Great for everyday use or light activity.

When selecting a brace, consider your specific needs, activity level, and the level of support required. It’s also advisable to consult with a healthcare professional for personalized recommendations and to ensure you choose the best option for your recovery.

Bottom Line

With all of this in mind, Posterior tibial tendonitis occurs when the tendon supporting your inner ankle and arch becomes inflamed, often due to overuse or strain.

You might feel pain, swelling, or tenderness along the inner ankle, especially during activity. If untreated, it can lead to a flattened arch or difficulty standing on your toes. It’s more common in women and people over 40, with women being up to four times more likely to develop it.

Frequently Asked Questions