Today, I’m going to talk about the posterior tibial tendon. Now, this tendon, which is not as well known as the Achilles tendon, is nonetheless just as important. The posterior tibial tendon is a very strong tendon that sits on the side of the foot coming from a muscle structure in the back of the leg. This muscle, or this tendon rather, from the muscle action basically resists the foot’s likelihood of flattening and stretching out and rolling outwards. This particular tendon, along with the muscle attached to it, helps to roll the foot inward, which is a very important motion during the walking cycle.
Where is the posterior tibial tendon located?
The posterior tibial tendon essentially begins as a muscle further back in the leg on the same side of your foot as the big toe. This posterior tibial tendon runs down along underneath the ankle bone and then attaches to a bone called the navicular,. In helping the foot to function better, when this muscle contracts, it basically causes the foot to roll inward, and that helps to resist the tendency of the foot to roll completely outward when you’re bearing full weight on your foot, and it also resists the activity of another muscle on the other side of the foot which forces that foot outward as well. Both of these muscles work in conjunction with each other in order to make the foot function properly.
Common posterior tibial tendon issues
Now, there’s a problem that often develops with this posterior tibial tendon in that it can get easily inflamed as well as damaged and irritated. We typically tend to see this in people who have flat feet, whose feet automatically roll outward as a result of their foot structure, which causes a lot of stress and strain to this tendon in the first place, and this tendon has to work harder to be able to stabilize the foot. However, we can also see this condition in people who have normal foot types who just happen to injure their tendon during an athletic activity or while hiking or walking on an uneven surface that caused their foot to roll back and forth a lot, so just walking on gravel or grass or sometimes even just walking on the beach on the unsteady surface of deep sand.
When this tendon becomes inflamed and irritated, it will start to hurt, and the area can become swollen. If the problems that started this inflammation in the first place are allowed to continue, unfortunately, this tendon can begin to degrade, and as this tendon begins to degrade, the foot in and of itself will actually begin to flatten more. This is the primary cause of why people develop flat feet later on in life is because of destructive changes to this particular tendon.
Posterior tibial tendon treatments
Now, treating this particular tendon when it becomes inflamed, another condition called tendonitis, treating this particular tendon is something that needs to be done early on to prevent some of these later changes, because, as the foot flattens out and this tendon starts to destroy itself more, other changes will occur to the bone structure in the back of the foot, which likely can lead to a massive amount of degeneration not only of the tendon but also of all the joints in the back of the foot. This can lead to a pretty serious painful condition.
So, early treatment’s very important when it starts to become inflamed, and that treatment basically consists of resting it, supporting it with a brace, also icing it and taking anti-inflammatory medications. Sometimes, that’s not enough and you have to use more substantial braces or even involve a physical therapist to try to help to stimulate the tendon into healing once it’s been stabilized from the excessive activity that was causing the tendonitis in the first place.
As this condition begins to progress, if it’s not treated, it can develop into a condition called posterior tibial tendon dysfunction, which is basically a three-stage disease process that gradually catalogs the destruction of this particular tendon and the associated bone structures next to it. That particular condition needs a much more substantial level of treatment, and that can include such basics, things as starting off with a prescription orthotic to stabilize the tendon itself all the way up to using very specified braces that are actually made of a mold of the foot, also called ankle foot orthosis, which cast and immobilize and stabilize the foot and the ankle structure while still allowing the person to be functional.
If none of these do the trick, and that condition continues to become destructive, then surgery is necessary in order to stabilize the tendon, try to get it to heal, and, unfortunately, in more advanced cases, you actually have to address the problem with the bone destruction and the joint destruction itself. So, surgical intervention, at least early on, consists of trying to get the tendon to stimulate healing by either using specialized radio frequency devices that will cause a stimulation of the healing tissue or by other types of surgical measures which will allow the tissue to begin to heal. Also, what’s usually necessary is moving the tendon downward a little bit to try to increase its ability to pull on the foot itself, and that can help it to decrease the strain associated with normal foot functioning on this tendon.
Sometimes, on the navicular bone, there is either a large bone that’s to the side of it or there’s actually a separate bone that might sit within where the tendon attaches to the bone itself. Often times, that can also be a source of irritation to the tendon, and, when surgery is performed, either that enlargement of the bone or that extra bone is also removed.
Now, if it gets to a more advanced stage and simply addressing the tendon isn’t going to help because the foot has flattened out severely at that point, then surgery is necessary to basically fuse the joints together so that there isn’t this continued process of joint destruction and flattening, and that involves fusing several joints in the back of the foot below the ankle that will keep the foot locked and stabilized into a good position so that the destruction doesn’t continue.