Posterior Tibial Tendon Rupture

with Rehab

ExitCare ImageTendons are soft tissues that connect muscle to bone. Tendons allow muscles to move the skeletal system. A complete tear of the posterior tibial tendon is known as a posterior tendon rupture. The posterior tibial tendon attaches the posterior muscles on the inner portion of the back of the lower leg (tibialis muscles) to foot. The posterior tibialis muscles help straighten (plantarflex) and rotate the foot inward (medially rotate) the foot. A posterior tibial rupture will result in a decreased ability to perform these tasks.

SYMPTOMS

  • A "pop" or tear felt and/ or heard in the area at the time of injury.

  • Pain, tenderness, inflammation, and/or bruising (contusion) around the medial inner side of the ankle.

  • Pain that worsens with dorsiflexion (opposite of plantarflexion) of the foot.

  • Decreased ankle strength.

  • Decrease in the prominence of the arch in the sole of the foot.

CAUSES

Tendon ruptures occur when a force is placed on the tendon that is greater than it can withstand. Common mechanisms of injury include:

  • An event that places great stress on the tendon (jumping or starting a sprint)

  • Direct trauma to the ankle.

RISK INCREASES WITH:

  • Sports that involve forceful and explosive plantar flexion (jumping or quick starts).

  • Poor strength and flexibility.

  • Previous injury to the posterior tibial tendon.

  • Corticosteroid injection into the posterior tibial tendon.

  • Obesity.

  • Poor vascular circulation.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Maintain a healthy body weight.

  • Arch supports (orthotics), if you have flat feet.

  • Limit ankle movement by taping, wearing a brace, or using compression bandages.

PROGNOSIS

In order to have the highest likelihood of returning to your pre-injury activity level, surgery is usually recommended with 4 to 9 months of rehabilitation afterwards.

RELATED COMPLICATIONS

  • Decreased ability to plantarflex.

  • Re-rupture of the posterior tibial tendon.

  • Prolonged disability.

  • Flat feet.

  • Arthritis of the foot.

  • Risks of surgery: infection, bleeding, nerve damage, or damage to surrounding tissues.

TREATMENT

Treatment initially involves resting from any activities that aggravate one's symptoms. Ice, medication, and elevation can be used to help reduce pain and inflammation. In order to have the best results, surgery is recommended. Surgery involves sewing (suturing) the ends of the torn tendon back together. If your surgeon cannot repair the tendon, then a replacement (reconstruction) surgery may be performed to use another tendon to replace the function of the ruptured tendon After surgery the ankle is immobilized, in order to allow the tendon to heal. After immobilization it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your caregiver. Contact your caregiver immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

  • Pain relievers may be prescribed as necessary by your caregiver. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Posterior Tibial Tendon Rupture

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Gastrocsoleus

  • Sit with your right / left leg extended. Holding onto both ends of a belt or towel, loop it around the ball of your foot.

  • Keeping your right / left ankle and foot relaxed and your knee straight, pull your foot and ankle toward you using the belt/towel.

  • You should feel a gentle stretch behind your calf or knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________.

times per day.

ExitCare Image RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot/ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation so your littlest toes rise slightly

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Posterior Tibial Tendon Rupture

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

ExitCare Image STRENGTH - Dorsiflexors

  • Secure a rubber exercise band/tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band/tubing should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band/tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return slowly, controlling the tension in the band/tubing.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair positioned on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel by only curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add ____________________ at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.