II. Physiology
- Posterior Tibial Tendon function
- Foot inversion and plantar flexion
- Medial longitudinal arch stabilization
III. Epidemiology
- Gender predominance in women
- Typically over age 40 years
IV. Causes
- Typically, no recollection of acute injury
- Twisting foot
- Stepping in hole
- Slipping from curb
V. Symptoms
- Years of pregressive pain along the lateral tarsal region
VI. Signs
- Pain and swelling posterior to medial malleolus
- Flat foot deformity
- Medial ankle instability (severe cases where the deltoid ligament stretched)
- Provocative factors
- Weight bearing
- Foot inversion against resistance
- Plantar flexion against resistance
- Specific testing
- Heel varus is absent when standing on tiptoe
- Pain with single-leg toe raise and unable to complete 10
- Plantar flexion ability lost (peroneal tendon rupture)
VII. Evaluation: Stages of Posterior Tibial Tendinopathy
- Stage 1
- Pain and swelling of posterior tibial tendon
- No foot deformity
- Patient can perform single-leg heel raise
- Stage 2
- Pain and swelling of posterior tibial tendon
- Patient cannot perform single-leg heel raise
- Flexible subtalar joint
- Pes Planus
- Midfoot adduction
- Stage 3
- Stage 2 and
- Subtalar joint is fixed
- Ankle Arthritis
VIII. Differential Diagnosis
- Medial Ankle Sprain (most common misdiagnosis)
- Flexor digitorum longus Tendinopathy
- Flexor Hallucis Longus Tendinopathy
- Tarsal Navicular Stress Fracture
- Tarsal Tunnel Syndrome
IX. Management
- RICE-M
- Immobilization (e.g. CAM Walker boot) for 2-3 weeks
- Shoe Orthotic (decrease foot pronation)
- Posterior tibial tendon strengthening
- Avoid Corticosteroid Injection (risk of posterior tibial tendon rupture)
- Orthopedic referral indications
- Failed conservative therapy above
- Stage 3 foot deformity (consider for stage 2)
X. Complications: Occur more often in the absence of treatment
- Foot deformity
- Posterior tibial tendon rupture
XI. References
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Disease or Syndrome (T047) |
| ICD10 | M76.82 |
| SnomedCT | 202881005 |
| English | posterior tibial tendinitis (diagnosis), posterior tibial tendinitis, posterior tibial tendonitis, posterior tibialis tendinitis, tibialis posterior tendinitis, Posterior tibial tendinitis, Tibialis posterior tendinitis, Tibialis posterior tendinitis (disorder), Posterior tibialis tendinitis |
| Spanish | tendinitis del músculo tibial posterior (trastorno), tendinitis del músculo tibial posterior |
