Posterior Tibial Tendonitis
Posterior tibial tendonitis, also known as posterior tibial tendon dysfunction or tibial tendonitis, is one of the most common conditions that affect the foot and ankle. Tibial tendonitis is denoted by the posterior tibial tendon becoming inflamed or swollen. This causes the tendon to be more unstable and less able to support the arch of the foot. The posterior tibial tendon is the tendon that connects at the calf and attaches to the bones of the foot. This tendon is designed to maintain the natural arch of the foot, maintain stability, and rotate the foot inward when walking.
What causes posterior tibial tendonitis?
Many cases of posterior tibial tendonitis begin with a period of irritation that typically occurs on the outside of the tendon. This area of the tendon is known as the paratenon, and when it is inflamed, the condition is known as paratendonitis. Another cause for posterior tibial tendonitis may be aging and degeneration. The tibial tendon begins to weaken after a lifetime of movements. This wear and tear may present itself as a loss of tendon fibers. The tibial tendon will attempt to heal from minor wear and tear, which causes scar tissue to form. This scar tissue slowly makes the tendon thicker to the point where a knot in the tendon forms. This condition is known as tendonosis, which causes this portion of the tibial tendon to become weaker than the rest of the tendon. This area of the tibial tendon is more prone to tearing, rupturing, or developing posterior tibial tendonitis.
What are the symptoms of posterior tibial tendonitis?
One of the most common symptoms of posterior tibial tendonitis is pain or discomfort in the instep of the foot. This pain may also be accompanied by swelling or inflammation along the tendon itself. Patients often report that pain within the foot and ankle are worse with physical activity or exercise. In more severe cases, the tendon may tear or rupture at a weak point. If the tibial tendon does rupture, it may cause the arch of your foot to fail, causing a flat foot.
How can Dr. Rozbruch diagnose posterior tibial tendonitis?
Physical examination of the foot and ankle is often all that is needed to accurately diagnose posterior tibial tendonitis. During a physical exam, Dr. Rozbruch may look for inflammation or swelling along the tibial tendon. Dr. Rozbruch may also examine your heel, as it may begin to tilt outward in some patients with posterior tibial tendonitis. An obvious sign of posterior tibial tendonitis is a flat foot in which the arch has collapsed. Dr. Rozbruch may ask you to do a calf raise where you place all of your weight on the ball of your foot and toes. If you are unable to successfully do a calf raise on one of your legs, it often points to a condition in your posterior tibial tendon. Dr. Rozbruch may also examine your leg to see your range of motion, mobility, and flexibility. In cases where Dr. Rozbruch is unsure of a diagnosis, he may order a foot or ankle MRI to view the tendons and ligaments.
What posterior tibial tendonitis treatments are available?
One of the earliest tibial tendonitis treatments includes a shoe insert to improve arch support in your footwear. A comfortable insert can provide support for the arch and reduce pressure on the posterior tibial tendon. In addition to a shoe insert, it is important to rest more often and reduce the time spent standing or walking if possible. Certain anti-inflammatory medications may be prescribed to help lessen any swelling or inflammation.
What posterior tibial tendonitis surgeries are available?
For patients who do not find relief from a tibial tendonitis treatment, posterior tibial tendonitis surgery may be required. In most cases, Dr. Rozbruch attempts to treat posterior tibial tendonitis nonsurgically but may suggest tendon surgery in more severe cases. Common posterior tibial tendonitis surgeries include posterior tibial tendon debridement, posterior tibial tendon repair, and posterior tibial tendon fusion.
Posterior Tibial Tendon Debridement
Posterior tibial tendon debridement can treat posterior tibial tendonitis and reduce the thickening of tissue around the tendon. Tibial tendon debridement involves removing the thick tissues around the tendon to reduce the pressure on the tibial tendon. Posterior tibial tendon debridement can also reduce the future possibility of the tibial tendon rupturing or tearing. This posterior tibial tendon surgery is typically performed through an incision just above the posterior tibial tendon at the instep of the foot. Dr. Rozbruch will then identify the posterior tibial tendon and remove any thickened tissue around it. The incision will then be closed with stitches, and bandages will be applied.
Posterior Tibial Tendon Repair
In some cases of a degenerated posterior tibial tendon, the tendon may need to be repaired to avoid the possibility of the tendon rupturing in the future. To begin posterior tibial tendon repair, an incision just above the tendon will be placed. The outer covering of the tendon will be divided. Any portion of the posterior tibial tendon that has experienced wear and tear will be removed. Dr. Rozbruch will then repair any tears in the posterior tibial tendon by suturing them together. In more severe cases, a posterior tibial tendon graft may be needed to fortify the tendon and reduce the possibility of the tendon rupturing. The covering of the tendon will then be repaired, and the incision will be closed with stitches.
Posterior Tibial Tendon Fusion
Posterior tibial tendon fusion is a tibial tendonitis surgery that is designed to correct a flat foot deformity caused by a collapsed arch. Tendon fusion surgery, also known as tendon arthrodesis, involves removing the joint between 2 bones and fusing these bones into 1 bone. Posterior tibial tendon fusion can reduce joint pain that is caused by degeneration or wear and tear. Tibial tendon fusion can also help properly realign the foot. In cases of a flat foot, Dr. Rozbruch may need to remove several joints and fuse multiple bones. The details of your posterior tibial tendon fusion will be discussed in detail with you prior to the day of your surgery.
What should I expect after a posterior tibial tendonitis treatment?
Patients with conditions of the posterior tibial tendon may benefit from physical therapy sessions. These sessions can help to control inflammation and pain within the foot and posterior tibial tendon. Stretches and exercises can also help improve the overall health of the ankle, foot, and calf by promoting the posterior tibial tendon to heal. Strength exercises for the foot can help support the arch of the foot. During physical therapy, your physical therapist may also help design inserts for your footwear to support your arch and reduce pressure on the posterior tibial tendon.
What should I expect after a posterior tibial tendonitis surgery?
Following posterior tibial tendon surgery, the soft tissues of the foot may take 2 months to properly heal. Your recovery time may vary depending on which tibial tendon surgery you are undergoing, your individual rate of healing, and the severity of your posterior tibial tendonitis. A cast or boot may need to be worn following tibial tendon surgery. Crutches may also be needed for the first few days after surgery to reduce any pressure placed on the posterior tibial tendon. If Dr. Rozbruch has used traditional stitches during your posterior tibial tendon surgery, they will be removed 10-14 days after your procedure. In more intensive posterior tibial tendon surgeries, physical therapy may be needed for several weeks to months. Initially, your physical therapist will help reduce inflammation or pain during these sessions. As physical therapy progresses, you will learn various stretches and exercises to help strengthen your foot, ankle, and calf.
How can I learn more about posterior tibial tendonitis?
To learn more about posterior tibial tendonitis, please request an appointment online or contact Dr. Rozbruch’s orthopedic office at 917.975.0061. Prior to an office visit, please fill out Dr. Rozbruch’s patient forms to expedite your first visit.