About Tibialis Posterior Tendon Dysfunction
Tibialis Posterior Tendon Dysfunction is a condition that affects the tibial posterior muscle and tendon – the muscle that starts in the top third of the inside of the calf; it comes down and around the back of the inside of the ankle and attaches onto different parts of the arch.
The condition can affect a lot of adults, but some people are more susceptible to experiencing it.
Women over 40 are the most vulnerable to experience an issue with this tendon; the tendon is responsible for giving dynamic stability to the foot and controlling how flat the foot can be. It also controls the ability for the foot to be stable for propulsion: for when you’re pushing off on your foot.
People don’t always present with pain on the inside of the ankle, however, which is one of the main problems of this condition, because in general, the injury to the tendon is what we will call ‘a low mechanism of injury’ – which is when the tendon is under stress or strain, in minute form, for a long period of time.
For example, people will often say that they were doing the same thing – gardening or going for a walk – and suddenly, they had a painful foot. Sometimes they are also aware that the foot has changed shape.
People will accept an injury more if they’ve fallen or had an accident; it’s harder for them be acceptant of the foot problem if this is something that has occurred over time.
Sometimes patients can present with pain on the outside of the ankle, and this is because the foot has collapsed so much that they’re getting impingement on the other side of the foot and ankle. What they’ll find is that they don’t feel very balanced on the foot; they may get pain down the inside of their ankle and onto the arch, and they will find they’re limping in an almost asymmetrical way. They won’t feel like they can walk on their foot comfortably.
Tibialis Posterior Tendon Dysfunction: what treatment modalities can you expect?
Before they see me, the first thing a patient can do is give their foot greater support. There is often a view – in this country and elsewhere – that as soon as you’re indoors you should take your shoes off and get into some slippers. For this patient group, it’s the wrong thing to do.
Many people would be surprised by how many steps they’re doing at home and how much weight they’re putting through their feet. I would recommend people wear strong, supportive footwear indoors as well as outdoors who suffer with foot pain.
The management of this condition, when you start to see a health professional, can vary, dependant on how progressed it is, and the level of pain experienced. If the foot has changed shape, the patient will normally need to be seen by an orthopaedic consultant. If their foot has changed shape and it’s painful, at the very least they’ll need to see someone like me – an orthotist, to assess the structures at fault and arrange a scan. Once he/she has this information, they can decide the best course of action. For those who will not need surgery, they will need to be seen by a physiotherapist and someone like me – an orthotist. My job is to functionally influence the load and the stress, and the stress and strain being exerted on the painful tendon.
There are people who will think the aim of a functional device that goes inside the shoes is to ‘correct’ – and that when the pain goes away that the device is no longer needed. This is not the case.
The aim of the device is to influence, to offload a structure that is over-exerted and is causing pain.
Therefore, once the device is not being worn, the foot is back to where it originally was. The patient may have less pain, but it is very likely that the symptoms will come back if the orthoses are no longer being used or the exercises are no longer being done.
Therefore, it’s not advisable to stop wearing them; orthosis do not correct deformities or correct alignment; they influence alignment and they influence deformities. As a clinician, we don’t sell anything; we prescribe devices and we prescribe treatments to reduce pain and improve quality of life.
There are patients who have this condition that will always benefit from seeing a physiotherapist. Physiotherapy colleagues are incredibly important in offloading and improving the strength, not just around the foot and ankle, but right the way through the lower limb and up into the core – that’s an important component of this.
If someone has used strengthening measures – i.e. the appropriate orthotic device prescribed by an appropriate physician – and they’re still in pain, they may need to be escalated to an orthopaedic surgeon.
The aim of surgery is to reduce pain and try to improve quality of life for the patient; it is not, unfortunately, to bring the foot back to where it once was before the foot became injured.
The level of return that people get when they’ve had intervention is varied and it’s not fair to say that everybody will achieve a certain outcome; everyone’s outcome is different, based on the deformity and whether there are any underlying foot problems prior to the injury of the tendon.
At that stage, the intervention is at the discretion and expertise of the foot and ankle surgeon.
Tibialis Posterior Tendon Dysfunction: what happens after your appointment?
Orthotic devices are designed to last for many years. With a condition like this, it’s reasonable and sensible that the foot and ankle should be reviewed every couple of years or so. There’s an awful lot to be said for common sense – and I’m a firm believer in educating the patient to empower them to know when they need to come in and see me.
Education is the most powerful treatment you can offer anybody; once the patient understands what to look for, they’ll know when to pick up the phone to query when and whether they need to come in.
