Understanding Posterior Tibial Tendinopathy

Overuse or Repetitive Strain: Activities such as running, jumping, or prolonged walking can lead to micro-tears in the tendon. Over time, this can result in inflammation and degeneration of the tendon fibers.

Foot Biomechanics: Abnormal foot mechanics, such as flat feet or overpronation (excessive inward rolling of the foot during walking or running), increase stress on the posterior tibial tendon, contributing to tendinopathy.

Age: Tendons naturally lose some of their strength and elasticity as we age, making them more susceptible to injury. The condition is more common in middle-aged adults.

Obesity: Excess body weight puts additional stress on the feet and tendons, increasing the likelihood of developing PTT.

Previous Injuries: A history of ankle or foot injuries, such as sprains or fractures, can predispose individuals to posterior tibial tendinopathy due to weakened structures in the foot and ankle.

Improper Footwear: Wearing shoes that don’t provide adequate arch support or stability can increase strain on the posterior tibial tendon, leading to tendinopathy.

Pain along the inner side of the ankle or foot: The most common symptom is a dull, aching pain along the path of the posterior tibial tendon. This pain is often worse with activity and may improve with rest.

Swelling: Inflammation around the tendon may cause swelling, which can make the foot and ankle appear puffy, especially near the medial (inner) side of the foot.

Flattening of the Arch: In severe cases, the tendon may weaken to the point where it can no longer support the arch of the foot, causing it to flatten (a condition known as adult-acquired flatfoot).

Difficulty Walking or Standing for Long Periods: As the condition progresses, the pain and dysfunction may make it difficult to walk, stand, or perform other activities that require weight-bearing.

Stiffness: The affected foot may feel stiff or tight, particularly in the morning or after periods of inactivity.

Weakness: As the tendon weakens, there may be a noticeable loss of strength in the foot, particularly when trying to push off the ground during walking or running.

Rest and Activity Modification: Rest is crucial in the early stages of PTT to allow the tendon time to heal. Modifying activities to avoid putting stress on the tendon, such as switching to low-impact exercises like swimming or cycling, can help reduce strain.

Physical Therapy: A physical therapist is essential in rehabilitation of PTT, crafting a personalized program to meet each patient’s needs. This includes exercises to strengthen the posterior tibial tendon, crucial for foot function and stability. The therapist assesses strength, flexibility, and foot biomechanics to target specific areas. Stretching and strengthening exercises, focusing on the calf, Achilles tendon, and intrinsic foot muscles, enhance flexibility and foot mechanics. Resistance training builds muscle strength to support the foot arch and prevent injury. Techniques to improve foot posture, are integral, alongside guidance on gait mechanics and body alignment. Education is key, with the therapist advising on exercise adherence and avoiding exacerbating activities. Addressing underlying issues like muscle imbalances or improper footwear aids long-term recovery. Regular follow-ups allow for progress monitoring and plan adjustments. This comprehensive approach supports recovery and empowers patients to maintain optimal foot health.

Orthotics: Custom-made insoles or arch supports can help correct abnormal foot mechanics, such as overpronation, which may reduce strain on the posterior tibial tendon and provide pain relief.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen can help reduce pain and inflammation in the affected area. These should be used as a part of a comprehensive treatment plan and not relied upon for long-term relief.

Ice Therapy: Applying ice to the affected area for 15-20 minutes several times a day can help reduce swelling and alleviate pain.

Corticosteroid Injections: In some cases, corticosteroid injections can provide short-term relief from pain and inflammation, though they are not typically used long-term due to potential side effects on tendon health.

Tendon Debridement: This involves removing damaged tissue and cleaning the tendon to promote healing.

Tendon Transfer: In cases of severe tendon dysfunction or complete rupture, a tendon transfer may be performed to restore function by using another tendon to compensate for the damaged posterior tibial tendon.

Osteotomy: If the foot structure has significantly changed (e.g., flatfoot deformity), an osteotomy may be performed to realign the bones and restore normal foot mechanics.

TenJet Procedure: The TenJet is a minimally invasive, tissue regeneration technique that can be an option for treating posterior tibial tendinopathy. This procedure uses a specialized device to deliver high-velocity saline jets to the affected tendon, a process known as hydrodissection. The TenJet procedure aims to remove scar tissue, debride damaged tendon fibers, and stimulate the body’s natural healing response.

The TenJet procedure is often preferred for individuals who have chronic tendon degeneration and are seeking a less invasive option than traditional surgery. It is performed through small incisions and generally results in less post-operative pain and a quicker recovery compared to more invasive procedures. The goal of the TenJet is to promote tendon healing by creating a favorable environment for the tendon to repair itself, reducing pain and improving function.