Tibialis posterior is a muscle which attaches to the back and outer portion of the tibia bone and the inner portion of the medial fibula and distally inserts itself onto the medial cuneiform and navicular in the inner part of the foot. This muscle is responsible for plantarflexion (pointing) and inverting (turning in) the ankle, along with supporting the medial arch of the foot. The tendon (which inserts the muscle onto the bone) of the tibialis posterior muscle, which we will be discussing today, starts around the inside of the ankle and continues to the insertion point in the navicular bone.
How does it occur?
Tendinopathies usually occur due to a number of reasons including:
- Large amount of unaccustomed load placed on a tendon such as increased frequency, weight or time in training.
- Poor biomechanics.
- Change in training environment – adding hills, change in surface.
- Change in footwear.
- Secondary to another injury – return to sport after ankle sprain or fracture
For the tibialis posterior tendon this usually occurs with activities such as calf raises with an increase in weight, running with poor biomechanics (flat feet, weaker hips) or changes in surface or footwear such as running on pavement rather than grass.
Signs and Symptoms
There can be many signs and symptoms that are associated with a tibialis posterior tendinopathy. A physiotherapist will take a thorough history including aggravators, frequency and duration of symptoms. Some more common symptoms that may be present if you have a tibialis posterior tendinopathy include:
- Pain with running, jumping and in some cases walking
- Pain sometimes when standing for extended periods of time
- Tenderness on the inside of the ankle and down into the arch of the foot.
- Swelling on the inside of the ankle and foot.
- Weakness when coming onto the toes and turning the foot inwards.
Treatment and Management
The treatment and management of a tibialis posterior tendinopathy depends on how long you have had the symptoms and how the injury occurred. If the pain is more acute in nature your treatment may consist of a period of offloading of the painful tendon, soft tissue work, medication, orthotics, exercise and activity modification. If the pain has been around for a while your treatment may be more exercise based and working on correcting movement patterns along with training loads. A physiotherapist will be able to do a thorough assessment to identify the best course of treatment for you.
If you are experiencing a tibialis posterior tendinopathy, get in contact with us here at Bend + Mend in the Sydney CBD to see one of our experienced Physiotherapists.