Posterior Tibial Tendon Injury

________________________________________________________________________

KEY POINTS

• A posterior tibial tendon injury is a problem with the tendons and muscles that extend from the back of your lower leg to your inner ankle and foot.
• You will need to change or stop doing the activities that cause pain until the tendon has healed.
• Treatment may include stretching and strengthening exercises, wearing a cast or a boot for several weeks, medicine, or surgery to repair the tendon.
• Warm-up exercises and stretching before activities may help prevent injuries.

________________________________________________________________________

What is a posterior tibial tendon injury?

A posterior tibial tendon injury is a problem with the tendons and muscles that extend from the back of your lower leg to your inner ankle and foot. Tendons are strong bands of tissue that attach muscle to bone. You use the posterior tibial tendon when you point your foot down and in, stand on your toes, and when you walk or run.

Tendons can be injured suddenly or they may be slowly damaged over time. You can have tiny or partial tears in your tendon. If you have a complete tear of your tendon, it’s called a rupture. Other tendon injuries may be called a strain, tendinosis, or tendonitis.

What is the cause?

A posterior tibial tendon injury can be caused by:

• Overuse of the tendon, such as from lots of running, intense exercise, or sports training or from doing a lot of work that causes you to bend at the knees and ankles.
• A sudden activity that twists or tears your tendon, such as jumping, starting to sprint, or a fall.

You are more likely to have a posterior tendon problem if you have a problem called over-pronation, which happens when your feet roll inward and your arch flattens out more than normal when you walk or run.

What are the symptoms?

Symptoms may include:

• Pain, swelling, or tenderness on the inner side of the shin, ankle, or foot
• Pain with lifting your foot
• Pain when you walk or run

How is it diagnosed?

Your healthcare provider will examine you and ask about your symptoms, activities, and medical history. Tests may include:

• X-rays
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of your foot and leg

How is it treated?

You will need to change or stop doing the activities that cause pain until the tendon has healed. For example, you may need to swim instead of run.

Your healthcare provider may recommend stretching and strengthening exercises to help you heal. Special shoes or shoe inserts may help.

If you have a severe injury, your healthcare provider may put your leg in a cast or boot for several weeks to keep it from moving while it heals. You may need to use crutches until you can walk without pain.

If you keep having pain, your provider may give you a shot of a steroid medicine. If these treatments don't work, you may need surgery to relieve the pain.

The pain often gets better within a few weeks with self-care, but some injuries may take several months or longer to heal. It’s important to follow all of your healthcare provider’s instructions.

How can I take care of myself?

To help relieve swelling and pain:

• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth, on the area every 3 to 4 hours for up to 20 minutes at a time.
• Do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over your tendon for 5 to 10 minutes. Do this several times a day while you have pain.
• Keep your lower leg and foot up on a pillow when you sit or lie down.
• Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.

Moist heat may help relax your muscles and make it easier to move your leg. Put moist heat on the injured area for 10 to 15 minutes at a time before you do warm-up and stretching exercises. Moist heat includes heat patches or moist heating pads that you can purchase at most drugstores, a wet washcloth or towel that has been heated in the dryer, or a hot shower. Don’t use heat if you have swelling.

Follow your healthcare provider's instructions, including any exercises recommended by your provider. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid, including how much you can lift, and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent a posterior tibial tendon injury?

Warm-up exercises and stretching before activities can help prevent injuries. If your shin, ankle, or foot hurts after exercise, putting ice on it may help keep it from getting injured.

Follow safety rules and use any protective equipment recommended for your work or sport. For example, wear the right type of shoes for your activities. Taping your foot or putting arch supports in your shoes can give extra support to your arch.