What is it?
The tibialis posterior is the deepest muscle on the back of the lower leg that travels down the leg and inserts onto the inside of the foot. It plays an important role in supporting the arch and assisting in preventing pronation of the foot under load. Either as a result of sudden increase in training load or in the presence of poor biomechanics, the tibialis posterior tendon may be placed under excessive load, resulting in tendinopathy.
Tendinopathy describes a continuum of changes to the tendon depending on the degree of overload and length of time this overload has been poorly managed. This can vary from a temporary stress shielding, reactive response in the case of recent overload, all the way to weakness and breakdown of the tendon as a result of prolonged, poorly managed load.
Pain on the inside of the ankle, extending down into the foot, following periods of weight bearing. The tendon often tends to ‘warm up’ and it becomes less painful over the course of an activity only to become more painful when you cool down. Typically, the pain is quite well localised and there will often be tenderness to touch as well as load the tendon.
The initial management of the condition involves relative rest, focusing on decreasing load the tendon to a level that it is capable of tolerating. Importantly, this is often not complete rest but simply decreasing training load. Bracing and taping to offload the tendon may be helpful at this point to assist in offloading and settling the tendon. Depending on the stage of the tendinopathy, anti-inflammatory medication may be useful.
The second stage of management involves addressing any weakness or biomechanical issues which may have caused or contributed to the development of the condition. This is done in conjunction with a program of gradually increasing load in order to strengthen and build capacity in the tendon. At this point, depending on how well your symptoms are controlled, there will generally be a gradual increase in general exercise.
The final phase of rehab for this injury depends on teh demands which you wish to place on it but will generally involve commencing some high level plyometric type exercises for the tendon and muscles of the lower limb and gradual return to full sport and activity with the guidance of your physiotherapist.