Nathaniel Zimmerman
CERTIFIED PEDORTHIST
2127 West 8th
Erie, PA 16505
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The posterior tibial tendon (cover) runs behind the inside bump on the ankle (the medial malleolus), across the instep, and attaches to the navicular bone on the inside of the foot and into the bottom of the foot. The tendon is important in supporting the ankle and arch of the foot and helps turn the foot inward during walking.
Problems with the posterior tibial tendon seem to occur in stages. Initially, irritation of the outer covering of the tendon, called the paratenon, causes a paratendonitis. This simply indicates that there is inflammation around the tendon as it runs through the tunnel behind the medial malleolus (inside ankle bone). As we age, the tendon is subject to degeneration within the substance of the tendon. This creates a situation where the tendon becomes thickened and weaker, possibly to the extent that a nodule forms within the tendon. The normal arrangement of the fibers of the tendon become jumbled, and the tendon loses strength. This condition is called tendonitis.
In many cases, the two conditions are present simultaneously. The weakened, degenerative tendon sets the stage for the possibility of actual rupture of the posterior tibial tendon. A posterior tendon rupture can be very debilitating.
Symptoms
The symptoms of tendonitis of the posterior tibial tendon include pain in the instep area of the foot and swelling along the course of the tendon. In some cases the tendon may actually rupture, due to weakening of the tendon by the inflammatory process. Rupture of the tendon leads to a fairly pronounced flat foot deformity that is easily recognizable.
Diagnosis
Diagnosis of this problem is usually apparent on physical examination. In some difficult cases, an MRI scan may be useful to determine whether the tendon has ruptured. Always discuss treatment plans with your physician.
Treatment
Treatment begins with an orthotic device (good supportive arch support), supportive footwear, decreased activity, and anti-inflammatory medications such as Ibuprofen or Aspirin.
Most people that are compliant with wearing orthotic devices and supportive shoes achieve relief from pain to live a normal, comfortable lifestyle. Compliance is the key to avoiding surgery. Avoid unsupportive, weak shoes.
Surgery
If surgery is required, it involves removing the thickened tissue around the tendon. This is done to try and decrease the symptoms of pain and to prevent rupture of the tendon. If the tendon has ruptured, surgery may be required to either repair the ruptured tendon, or to replace it with a tendon graft. In cases which have been neglected, and a fixed flatfoot deformity is present, a fusion (arthrodesis) of the foot may be required.