The tibialis posterior tendon may become damaged or inflamed.
Pain of varying degrees is felt around the ankle.
The diagnosis is usually based on symptoms and an examination and sometimes imaging tests.
Depending on the disorder, orthoses and surgery or therapy to relieve inflammation can help.
(See also Overview of Foot Problems Overview of Foot and Ankle Problems Some foot problems start in the foot itself, for example, resulting from a foot injury. Problems can occur in any bone, joint, muscle, tendon, or ligament of the foot. Foot and ankle fractures... read more .)
The tibialis posterior tendon helps maintain the normal arch of the foot.
Tibialis posterior tendinosis is usually caused by an excessive ongoing strain caused by a problem with the way the foot moves. Most often, the person has a low arch, and the foot tends to turn outward when walking and appears flat when standing. Tendon dysfunction may further contribute to flattening of the arch. The tendon may tear completely in older adults and in people who had a previous injury or have chronic dysfunction. Tendon rupture may be a cause of tibialis posterior tendinosis in a young person with sudden arch collapse.
Tibialis posterior tenosynovitis begins with sudden inflammation of the tendon sheath. The tendon can be affected by inflammatory disorders, such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more or gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more .
In tibialis posterior tendinosis, early on people have occasional pain behind the inner ankle with increased activity. In time, the pain becomes severe, and swelling occurs. Normal standing and walking become more difficult. Standing on the toes is usually painful and may be impossible if the tendon is completely torn. If the tendon tears completely, the foot may suddenly flatten (called arch collapse) and pain may be felt in the sole.
In tibialis posterior tenosynovitis, pain typically occurs suddenly and the tendon may feel thick and swollen as it winds around the bump on the inside of the ankle (medial malleolus).
In some cases when the tendinosis has been long-standing, the arch of the foot may gradually fall, and the foot will appear flatter. These bony changes can also cause osteoarthritis in some of the bones of the foot and may progress to the ankle.
A doctor's examination
Sometimes x-ray or MRI (magnetic resonance imaging)
Doctors can often base the diagnosis on the person’s symptoms and the results of an examination. However, sometimes an x-ray or MRI Computed tomography (CT) and magnetic resonance imaging (MRI) A doctor can often diagnose a musculoskeletal disorder based on the history and the results of a physical examination. Laboratory tests, imaging tests, or other diagnostic procedures are sometimes... read more is necessary to rule out other causes of ankle pain, confirm the diagnosis, and to see the extent of tendon damage.
For tibialis posterior tendinosis, orthoses and braces or surgery
For tibialis posterior tenosynovitis, anti-inflammatory therapy
For tibialis posterior tendinosis, devices placed in the shoe (orthoses) and ankle braces worn with supportive shoes or boots are usually sufficient. Complete tears are treated surgically so people can function normally again. Surgery is especially important in young active people with tears that develop suddenly.
For tibialis posterior tenosynovitis, rest and nonsteroidal anti-inflammatory drugs Nonsteroidal Anti-Inflammatory Drugs Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more (NSAIDs) are used.