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Pain in the inside of your ankle or foot?

Tibialis Posterior Tendinopathy is an overuse injury that is characterised by tissue damage of the tibialis posterior tendon, resulting in pain at the inner aspect of the ankle or lower leg.

The tibialis posterior muscle is located in the posterior region of the leg and originates from both the posterior aspects of the tibia and fibula. The muscle then descends down the inner aspect of the leg and medial ankle where the tendon inserts onto various bones that make up the midfoot. Tibialis Posterior is responsible for the inward motion of the ankle (inversion), pointing the toes towards the ground (plantar flexion), as well as helps to maintain the arch of the foot.


Due to the functions of the tibialis posterior muscle and tendon, it is particularly active when performing weight bearing activities such as running and jumping. Whenever the muscle contracts or is stretched, tensile load is placed through the tendon. When this load exceeds the strength of the tendon, either through too much force or repetition, damage or micro tears can occur. Tibialis posterior tendinopathy is characterised by degeneration and sometimes swelling to the tendon, which can occur through a single traumatic event where too much force is exerted onto the tendon beyond what it can normally withstand, or more commonly due to repetitive stress and overuse.


Causes:

  • Overuse injury, generally caused by repetitive or prolonged activity such as walking and running

  • Poor foot biomechanics such as flat feet

  • Inappropriate footwear such as flat soled or worn out shoes

  • Improper training which includes sudden increase in duration, frequency and/or intensity

  • Inadequate recovery periods from training or sport

  • Inadequate warm up

  • Inadequate rehab from previous lower limb injury

  • Single traumatic event

  • Particularly common in long distance runners, basketball players and footballers

  • Forefoot runners

  • Muscle weakness or tightness (particularly in the calf muscles and glutes)

  • Joint stiffness (ankle, foot, knee, hip)


Signs and symptoms:

  • Pain on the inner aspect of the ankle and lower leg

  • Aching pain or stiffness that increases with rest post activity

  • Pain that eases when warming up for activity

  • Pain tends to be of a gradual onset and worsens over weeks/months when continuing with aggravating exercises

  • Pain with palpation of tibialis posterior tendon and active/resisted plantar flexion and eversion


Treatment

Treatment for tibialis posterior tendinopathy depends on the individual and their contributing factors to the injury. The practitioner will also take into account the severity of the condition, how long symptoms have been present for as well as the lifestyle/activity levels of the individual. The first phase of treatment is revolved around protection, pain relief and reducing inflammation, which is typically treated through RICE and immobilisation (can be done through taping/strapping techniques or the use of a CAM walker depending on severity). Once the person is able to weight bear pain free the practitioner is able to incorporate range of motion and strengthening exercises, as well as integrating other treatment options that will enhance rehab and help speed up recovery. Some treatment modalities that we are able to utilise in the clinic that compliment strengthening exercises include shockwave therapy, dry needling and orthotics.


If you are experiencing any pain associated with a suspected achilles injury, or have any other questions please contact our local Podiatrists/Physiotherapists in Oakleigh or Kew on (03) 9568 1011. You can also book an appointment online at www.msppc.com.au.




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