Comfort Shoe Specialists
11693 Manchester Rd
St. Louis, MO 63131
314-822-3300
Posterior
Tibial
Tendonitis
and
Medicare Providers
Introduction
Because we use our feet continuously, tendonitis in the foot is a common
problem. One of the most frequently affected tendons is the posterior tibial
tendon.
Anatomy
The posterior tibial tendon (Top) 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 (similar to a nylon rope) becomes
jumbled, and the tendon loses strength. This condition is called tendonosis.
In many cases, the two conditions are present simultaneously. The weakened, degenerative tendon sets the stage for the possibility of actual rupture (Below) 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.
(Inside view of the foot)
Diagnosis
Diagnosis of Posterior Tibial tendonitis 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.
Medical Treatment
Treatment of posterior tibial tendonitis begins with an
orthotic devices (good supportive arch support), supportive footwear, decreased
activity, and anti-inflammatory medications such as ibuprofen or aspirin.
What to expect
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. Most
tears will not simply be repairable, unless they only recently occurred.
Usually, another tendon in the foot, such as the tendon that flexes the four
lesser toes (bends them down) is used as a tendon graft to replace the function
of the posterior tibial tendon. Finally, in
cases which have been neglected, and a fixed flatfoot deformity is present, a
fusion (an arthrodesis) of the foot may be required.
Other names describing this condition are tibialis posterior tendonitis, adult flatfoot, unable to raise up on the toes, collapsed arch, ankle falling inward, and simply post tib.