Physiotherapy for Posterior Tibial Tendonitis

Introduction

One of the most frequent issues with the foot and ankle is the malfunctioning of the posterior tibial tendon. The posterior tibialis tendon, located in the rear of the inner ankle, can get injured, resulting in posterior tibialis tendonitis. This tendon joins the inner foot and the leg muscles. When the posterior tibial tendon sprains or tears, it results. As a result, the tendon cannot support and stabilize the foot's arch, leading to flatfoot. One of the most crucial tendons in the leg is the posterior tibial tendon. The posterior tibial tendon, which connects the calf muscle to the bones inside the foot, is a tendon that joins forces to bones. The tendon's primary job is to support the foot and hold up the arch during the walk.

What Symptoms and Signs Indicate Posterior Tibialis Tendonitis?

1. When standing on the ball of the foot or when the foot is flexed, there may be discomfort, tenderness, or swelling across the back and the inner section of the ankle.

2. There may also be pain with ankle mobility, particularly when pushing off or pressing down with the front of the foot.

3. The arch will eventually collapse if the tendon gets irritated or ruptured.

4. When the tendon is located on the inside of the foot and ankle, there is pain. Swelling nearby may or may not be related to this.

5. Pain that worsens while one is active. Running is one of several high-intensity, high-impact sports that may be highly challenging. As a result, some patients may struggle to move or stay still for an extended period.

6. Ankle pain on the outer side. The heel bone may move to a new place outwardly as the foot collapses. As a result, the outer ankle bone may be compressed. The same kind of discomfort is caused by arthritis in the back of the foot.

What Is Physical Assessment Before Starting Physiotherapy?

The doctor will inquire about the symptoms and obtain a thorough medical history. Then, the doctor will examine the feet and ankles to see whether these symptoms are present.

1. The posterior tibial tendon swelling. This swelling extends from the inside of the foot and ankle to the lower thigh.

2. The arch will have collapsed, and the heel may be tipped outward.

3. Usually, just the fifth toe and a portion of the fourth toe are visible while looking at the heel from the back of the patient. The little toe is more visible in flatfoot deformities.

4. Test of the "single limb heel raise." A healthy posterior tibial tendon must stand on one leg and rise on "tiptoes." When the patient cannot balance on one leg when elevating the heel, there may be a problem with the posterior tibial tendon.

5. The doctor could attempt to rotate the foot. Different treatments are recommended for posterior tibial tendon injuries depending on the foot's flexibility. There will need to be another type of treatment than with an adjustable foot if there is no mobility or restriction.

6. The ankle's range of motion is compromised. Dorsiflexion, the ankle's upward mobility, can be restricted in flatfoot. The calf muscles' tightness is related to the restricted range of motion.

What Is the Treatment for Posterior Tibial Tendonitis?

Care For Posterior Tibial Tendonitis Without Surgery -

Most instances resolve without surgery if handled quickly enough. These therapies might include:

• RICE (rest, ice, compression, and elevation).

• Immobilization.

• Antibiotics and painkillers.

• Bracing or other orthotic tools.

• Adjustments to shoes.

• Physical therapy.

Surgical Treatment for Posterior Tibial Tendonitis -

• Surgery is indicated if the symptoms worsen or do not improve with non-surgical care.

• Several operations may be used, and the best action for anyone will depend on several variables.

• Some surgical therapies may require a complete ankle arthroplasty or tendon transfer.

Physiotherapy for Posterior Tibial Tendonitis: Will It Be Helpful?

The foot and ankle discomfort from posterior tibial tendonitis can be relieved with physical therapy. The recovery from physical therapy is centered on the following:

• Foot and ankle range of motion in a normal position.

• Strength.

• Mobility.

The physical therapist will evaluate the condition at the initial visit to identify the primary factor causing the pain.

• Depending on the unique circumstances, the treatment plan will include many elements, but exercise is often one of the major treatment methods.

• One of the greatest methods to manage discomfort is exercise. The physical therapist could suggest and guide anyone through a specific workout based on the particular condition.

• Proper foot alignment when walking or running results from increased mobility. Some of the most effective stretches are runners warm up, ankle stretches, and stretching the hamstrings.

• The physical therapist may recommend strengthening exercises for the knees and hips since these muscles regulate the posture of the entire leg, like hip hikes, bridges, leg extensions, squats, and lunges.

• These exercises are designed to make the posterior tibial tendon strong enough to support the arch foot and provide them control over how the foot and ankle move while participating in various activities.

Toe Pick-Ups:

• In this exercise, one should pick up little things with their toes, such as pebbles, marbles, or tiny toys, and puts them in a bucket or other box.

Caterpillar Exercise to Strengthen The Arch:

• To begin the caterpillar exercise to strengthen the arch, lie on the back with knees bent and the feet flat on the ground approximately two feet apart from the butt.

• Pull the toes back toward the heels while raising the arches of both feet. Arches should be relaxed, and feet should be moved backward toward the butt.

• Repeat the exercise while letting the feet move in a caterpillar fashion toward the glutes.

• Repeat the process in reverse once the feet almost touch the butt, slowly sliding them away from the butt in the same direction.

Arch Raises:

• Lie back in a chair with feet flat on the floor and the knees bent at a 90-degree angle.

• With no heel lift or toe curl, raise the arch of one foot off the floor. It is more difficult than it seems.

• When done correctly, the foot, lower leg, and thigh muscles should feel strained.

Alphabet Writing:

• By picturing a pencil between the toes, pointing the toes outward, and "writing" the alphabet in the air in front of oneself, individuals may strengthen their entire foot.

• One of the simplest methods to develop the muscles in the ankle is to use a resistance band to do exercises like ankle dorsiflexion and plantarflexion.

Additional therapies during therapy could include:

• Ultrasound.

• Kinesiology.

• Bracing.

• Massage.

• Electrical stimulation.

Conclusion

An interprofessional team approach that includes doctors, specialists, physiotherapists, and pharmacists is needed to provide the best patient care. A slow-onset ailment, posterior tibial tendon dysfunction often affects mostly middle-aged, obese women. Obesity, hypertension, diabetes, steroid usage, and seronegative arthropathies are risk factors. In addition, patients may express concerns about exacerbating an existing limp, medial ankle discomfort, edema, or mobility issues. Although the condition is poorly understood and can be misdiagnosed in its early stages, quick treatment can prevent deformity and the need for surgery.