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Inner Ankle Pain: Causes, Symptoms, and Treatments for Posterior Tibialis Tendinopathy




Are you experiencing persistent pain on the inner side of your ankle? It might be more than just a minor discomfort. Posterior tibialis tendinopathy (PTT) could be the culprit. This condition affects the posterior tibialis tendon, which plays a crucial role in supporting the arch of your foot during everyday gait, running, and lifting. In this blog post, we'll delve into what PTT is, how it develops, its symptoms, and the best approaches for treatment and management.


What is Posterior Tibialis Tendinopathy?


Posterior tibialis tendinopathy refers to the inflammation or degeneration of the posterior tibialis tendon, which runs along the inside of your ankle and foot. It originates from the posterior surface of the tibia and fibula bones in the lower leg and extends down to attach to the inner arch bones in the foot. The posterior tibialis plays a pivotal role in maintaining the structural integrity and acts as a dynamic stabilizer for the medial arch of the foot. This muscle and tendon complex supports the arch by counteracting excessive pronation (inward rolling of the foot) during weight-bearing activities such as walking, running, jumping, skiing, lifting, etc.


When the posterior tibialis tendon becomes strained or injured, several physiological changes occur. The tendon may experience micro-tears or inflammation due to overuse or biomechanical stress. This inflammation disrupts the normal function of the tendon, leading to pain and swelling. Over time, chronic strain can cause degenerative changes in the tendon, such as collagen breakdown and reduced tensile strength. This can compromise the tendon’s ability to support the arch effectively and maintain proper foot mechanics, resulting in increased stress on other structures of the foot and ankle.


Furthermore, the posterior tibialis tendon interacts closely with other muscles and tendons around the ankle, such as the Achilles tendon and the flexor digitorum longus. Disruption in the posterior tibialis tendon can affect the overall biomechanics of the lower limb, potentially leading to compensatory gait patterns and increased risk of secondary injuries.


Causes and Risk Factors

Posterior tibialis tendinopathy often results from repetitive stress or overuse. Some common causes and risk factors include:


  1. Overuse and Repetitive Strain: Engaging in activities that involve excessive running, jumping, or tasks requiring loaded arch control, such as lifting heavy weights, can place significant stress on the posterior tibialis tendon. If there is insufficient recovery time between these high-impact events, the tendon can become overloaded and prone to injury.

  2. Flat Feet (Pes Planus): Individuals with flat feet or fallen arches experience increased load and stress on the posterior tibialis tendon because the tendon must work harder to stabilize the foot’s arch while also in a less advantageous length. This added strain makes the tendon more susceptible to tendinopathy, as it is forced to compensate for the lack of natural arch support.

  3. Muscle Endurance Weakness: The posterior tibialis muscle must have adequate endurance and strength to effectively support and stabilize the arch during prolonged or intense activities. If the muscle lacks the necessary endurance, it can fatigue quickly, placing excessive stress on the tendon and increasing the risk of injury.

  4. Poor Knee and Hip Control: Abnormal foot mechanics can arise when the hip lacks sufficient strength or muscle control to maintain proper knee alignment. When the knee rotates inward or collapses, it leads to increased pronation of the foot. This additional pronation places greater stress on the posterior tibialis tendon, exacerbating its load and contributing to potential injury.

  5. Aging: As we age, the tendons in our body, including the posterior tibialis tendon, naturally lose flexibility and elasticity. This reduced flexibility makes tendons more vulnerable to injury and less able to withstand the repetitive stresses of physical activity.


Recognizing the Symptoms

PTT can present with a range of symptoms, which may vary in severity. Common signs include:


  • Inner Ankle Pain: Pain typically occurs along the inner side of the ankle and can radiate to the arch of the foot.

  • Swelling: Inflammation around the tendon can cause noticeable swelling.

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

  • Weakness: Difficulty with foot movements or a feeling of instability can indicate tendon weakness.

  • Decreased Function: Pain and swelling may limit your ability to walk, run, or participate in physical activities.


Diagnosis and Evaluation

If you suspect you have posterior tibialis tendinopathy, it's essential to consult your physical therapist. They will perform a thorough examination, which may include:


  • Subjective History: Your physical therapist will begin by discussing your symptoms, including the onset, duration, and nature of your pain, as well as any recent activities or injuries that might have contributed to the condition.

  • Functional Observation: They will observe your movement patterns such as walking, squatting, hopping, and lunging to identify any abnormalities or compensatory strategies that might be affecting your foot and ankle mechanics.

  • Muscle Strength Testing: The therapist will assess the strength of the muscles around your ankle, leg and hip to determine if weakness in the posterior tibialis or surrounding muscles is contributing to your symptoms.

  • Joint Mobility Assessment: They will evaluate the motion in your ankle and surrounding joints to identify any limitations or stiffness that may be affecting your overall foot function.

  • Palpation of Sensitive Tissues: The therapist will gently palpate the areas around the posterior tibialis tendon to identify points of tenderness, swelling, or other signs of inflammation that can confirm the diagnosis of tendinopathy.



Treatment Options

Managing and treating PTT often involves a combination of approaches. Here are some common strategies:


  1. Rest and Activity Modification: Reducing or modifying activities that exacerbate symptoms can help alleviate stress on the tendon.

  2. Footwear Adjustments and Orthotics: Changes in footwear and orthotics are not long term solutions but providing increased arch support while the tissue is highly irritable can help with the pain and first phase of the recovery process.

  3. Muscle Strengthening: Acutely, isometric contraction exercises can decrease the symptom irritability and begin to strengthen the impaired muscles. When ready, it is imperative to progressively overload the tendon to encourage collagen remodeling and tendon elasticity. 


Conclusion

Posterior tibialis tendinopathy is a common condition that can significantly impact your quality of life if left untreated. By understanding its causes, recognizing the symptoms, and seeking appropriate treatment, you can manage and overcome this condition effectively. If you’re experiencing inner ankle pain or suspect you might have PTT, don’t hesitate to contact us for guidance to get back on track and enjoy an active, pain-free lifestyle.



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