What is tibialis posterior tendinopathy?
The tibialis posterior muscle begins in the back of the lower leg. The muscle’s tendon runs around the inside of the ankle and inserts into various areas of the foot. This muscle supports the medial longitudinal arch of the foot (this is what’s typically referred to when you talk about “the arch”), controlling how much and how fast the foot can roll in, or “pronate.” This arch absorbs the majority of shock from impact while you perform activities like jumping, running, or walking.
Tibialis posterior tendinopathy is a common overuse injury. In some cases, degeneration of the tendon itself may occur, while only acute inflammation may be present in other cases. Long term injury to this tendon can contribute to its dysfunction, resulting in fallen arches or a change in the shape of the foot.
What do people experience with tibialis posterior tendinopathy?
Symptoms are typically isolated to the middle or inside of the ankle. You may have symptoms such as:
- Swelling in or around the inside of the ankle
- Morning stiffness in the ankle that eases with activity
- Pain exacerbated by activity
- Pain that radiates up the inside of the lower leg, or down beneath the foot
- Flat feet
- Repetitive movement causing strain on the tibialis posterior muscle
- Increase running mileage or training intensity too quickly can be a source of injury
- Ill-fitting or worn out footwear
- Unsupportive footwear, such as sandals or poorly structured shoes
- Uneven terrain – avoid surfaces with uneven terrain like trails or loose gravel as they may place a greater strain on the involved tissues
- High impact and high volume or intensity of exercise
- Depending on your body’s mechanics, being overweight or obese may increase the strain on the muscles and tendons in your lower legs
Options for treatment
Treating tibias posterior tendinopathy may require a “team” for treatment and a successful recovery. Here are some people and tactics to consider.
- Family physician: first line of defence for treatment
- Physiotherapist and/ or kinesiologist: to assist with exercises, stretches, and/or lifestyle alterations
- Pedorthist: control motions of the foot that may be impacting the strain on tibialis posterior
- Bracing: to control severe excessive pronation
- Massage therapist: to assist with muscular stiffness or discomfort
Tibialis posterior tendinopathy & footwear
Appropriate footwear selection is important for daily comfort and is dependent on your specific mechanics. In general, footwear with cushion and support work well while recovering from tibialis posterior tendinopathy. No matter which shoe you select, proper fit is vital. Length, width, depth and heel height are all important considerations to make. Consult with your SoleScience Pedorthist for recommendations specific to your individual foot type and intended use.
Modified training for tibialis posterior tendinopathy
Staying active with tibialis posterior tendinopathy means being able to support the medial longitudinal arch and reduce the strain on the tibialis posterior muscle enough to reduce symptoms. This can be done in several ways, including choosing more supportive footwear, adding custom orthotics or off-the-shelf orthoses, and bracing. These devices work in similar but slightly different ways to reduce strain on the tibialis posterior muscle, thus reducing pain during and after activity.
High impact activity can cause a greater amount of strain on muscles than lower impact activity. Choosing low-impact activities can reduce the amount of abrupt movement and strain on the muscles and limit the overall strain on injured structures.