Posterior Tibial Tendon Tendinitis

with Rehab

ExitCare ImageTendonitis is a condition that is characterized by inflammation of a tendon or the lining (sheath) that surrounds it. The inflammation is usually caused by damage to the tendon, such as a tendon tear (strain). Sprains are classified into three categories. Grade 1 sprains cause pain, but the tendon is not lengthened. Grade 2 sprains include a lengthened ligament due to the ligament being stretched or partially ruptured. With grade 2 sprains there is still function, although the function may be diminished. Grade 3 sprains are characterized by a complete tear of the tendon or muscle, and function is usually impaired. Posterior tibialis tendonitis is tendonitis of the posterior tibial tendon, which attaches muscles of the lower leg to the foot. The posterior tibial tendon is located in the back of the ankle and helps the body straighten (plantarflex) and rotate inward (medially rotate) the ankle.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, and/or redness over the back of the inner ankle at the posterior tibial tendon or the inner part of the mid-foot.

  • Pain that worsens with plantarflexion or medial rotation of the ankle.

  • A crackling sound (crepitation) when the tendon is moved or touched.

CAUSES

Posterior tibial tendonitis occurs when damage to the posterior tibial tendon starts an inflammatory response. Common mechanisms of injury include:

  • Degenerative (occurs with aging) processes that weaken the tendon and make it more susceptible to injury.

  • Stress placed on the tendon from an increase in the intensity, frequency, or duration of training.

  • Direct trauma to the ankle.

  • Returning to activity before a previous ankle injury is allowed to heal.

RISK INCREASES WITH:

  • Activities that involve repetitive and/or stressful plantarflexion (jumping, kicking, or running up/down hills).

  • Poor strength and flexibility.

  • Flat feet.

  • Previous injury to the foot, ankle, or leg.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique. When possible, have a coach correct improper technique.

  • Complete rehabilitation from a previous foot, ankle, or leg injury.

  • If you have flat feet, wear arch supports (orthotics).

PROGNOSIS

If treated properly, then the symptoms of tendonitis usually resolve within 6 weeks. This period may be shorter for injuries caused by direct trauma.

RELATED COMPLICATIONS

  • Prolonged healing time, if improperly treated or re-injured.

  • Recurrent symptoms that result in a chronic problem.

  • Partial or complete tendon tear (rupture) requiring surgery.

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. Often times, your caregiver will recommend immobilizing the ankle to allow the tendon to heal. If you have flat feet, the you may be advised to wear orthotic arch supports. If symptoms persist for greater than 6 months despite non-surgical (conservative) treatment, then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

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

  • Any medications produce adverse side effects.

EXERCISES

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

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 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 this exercise __________ 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 - 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 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.

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 exercise __________ times per day.

ExitCare Image STRETCH – Gastroc, Standing

  • Place hands on wall.

  • Extend right / left leg, keeping the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________ seconds.

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

ExitCare Image STRETCH – Soleus, Standing

  • Place hands on wall.

  • Extend right / left leg, keeping the other knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

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

STRENGTHENING EXERCISES - Posterior Tibial Tendon Tendinitis

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 (ie. 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 - 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 Eversion

  • 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.

  • Drawing the band/tubing across your opposite foot, slowly, pull your little toe out and up. Make 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 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.