The posterior tibial tendon starts in the calf, stretches down behind the inside of the ankle, and attaches to bones in the middle of the foot. This tendon helps hold the arch up and provides support when stepping off on your toes when walking. If it becomes inflamed, over-stretched or torn, it can cause pain from behind the inside ankle bone right down into the arch region, and the sole of the foot. If it gets worse, even the outside of he ankle can hurt. Over time, it can lead to loss of the inner arch on the bottom of your foot, so it looks almost as if you're walking on your ankle bone.
Signs and symptoms of posterior tibial tendon dysfunction include:
- Gradually developing pain on the inner side of the ankle or foot.
- Loss of the arch and the development of a flatfoot.
- Pain and swelling on the inside of the ankle.
- Tenderness over the midfoot, especially when under stress during activity.
- Weakness and an inability to stand on the toes.
People who are diabetic, overweight, or hypertensive are particularly at risk. X-ray s, ultrasound , or MRI may be used to diagnose this condition.
There are some children who are very loose-jointed, and for whom this can be a real problem. These are often the children who stop playing and running as much as they had, because they either get too tired, or because they hurt too much. Since children don't tend to tell parents about these things, you have to keep an eye on them to notice any changes. (As an aside, this tends NOT to be a surgical case - we get a pair of custom-made orthotics to control the feet, which helps the bones develop properly. Generally, we notice this sort of thing when the child is around 5, 6, or 7 years old.)
Left untreated, posterior tibial tendon dysfunction may lead to flatfoot and arthritis in the hindfoot. Pain can increase and spread to the outer side of the ankle.
Treatment includes rest, over-the-counter nonsteroidal anti-inflammatory drugs, and OTC ankle braces. If these don't work, we would consider immobilization of the foot for six to eight weeks with a rigid below-knee cast or boot to prevent overuse. Note: Please consult your physician before taking any medications.
The other patient group susceptible to this problem is usually around 70, and has been walking "funny" for years. Every step hurts. These are the people who benefit most from custom-made braces that will fit into most shoes. No one likes to wear them (Dr Hickey has one, himself, for those bad days), but they all say they wouldn't part with them for the world.
