Patients who complain of pain and swelling under the inner (medial) ankle bone or the arch may be suffering from a posterior tibial tendon injury. As the injury progresses, it may limit one’s ability to push-off without pain. In excessive cases, one may find it difficult to balance on one foot or tiptoe.
The posterior tibial muscle/tendon complex arises from the back of the inner leg and courses beneath the medial ankle bone and attaches under the navicular bone of the arch. It supports the arch while you are standing, walking, and running. When active, the area is kept warm and loose. While sleeping, the muscle may tighten and spasm as a response to the stress placed upon it during the day. Therefore, pain may be prevalent when arising from rest and as stresses are increased to it during the day, pains may be increased by evening.
This condition is most seen in those who with excessively collapsed arches, i.e. flatter footed individuals. Many people are born with a low-arched foot structure. Over the time, the condition worsens leading to a flatter foot. Symptoms are exacerbated by stress applied to the muscles and tendons from excessive standing, walking, running, jumping, squatting, weightlifting, and pivoting activities. Once the tendon is irritated, swelling is often noted along with pain.
Treatment at our office includes a specialized biomechanical examination of one’s foot and leg structure. Once measurements are taken, we make flexible temporary orthotic devices with intrinsic corrections to hold the foot in a more optimal position. For those with severe swelling, a brace is fit and placed in the shoe (athletic shoe preferred) so that one may walk in a more satisfactory way. Weightbearing x-rays taken in our office also help to determine if there are other contributing factors causing pain such as an extra bone of the arch (i.e. accessory navicular bone). For recalcitrant cases, an MRI or diagnostic ultrasound is performed to determine the extent of soft tissue injury or tear. Tendinopathy and/or tears are often treated in our office with the use of EPAT acoustic shockwave treatment. Shockwave treatment is discussed in a separate section of this website. Most patients return to the office within 1 to 2 weeks reporting improvement in their condition. Physical therapy and/or home exercises are helpful to reduce swelling and strengthen the supporting muscles. For those with flat or strained feet, wearing custom orthotics in different shoes will help prevent recurrence of this condition.
For those individuals presenting to our office with a chronic tendon injury that despite previous care did not heal, than one of our foot and ankle specialists will help to reconstruct the tendon and/or foot structure. This is performed through various techniques including tendon transfers or repositioning one’s foot bones to improve alignment. Please refer to the “Flat Feet” section of this website for additional information. Should you or someone you know suffer from this condition, please do not hesitate to call our office for an appointment.
Written by Richard T. Braver, DPM, FACFAS