Physiotherapist during an Achilles tendon treatment
Physiotherapist during an Achilles tendon treatment

Posterior Tibial Tendonitis/Dysfunction/Tear (by Richard Blake, DPM)

    The posterior tibial tendon is the major tendon to support the main arch of your foot. Damage to the tendon causes arch collapse to a major degree. Any sign that this tendon is having (beginning to have) problems must therefore be over-treated to avoid long-term issues. It is one of the most common surgeries on my patients because of their disabilities. I work long and hard on each one of these patients both trying to avoid surgery (usually) or in their post-surgical rehabilitation. I encourage you to see my videos on YouTube for posterior tibial tendon problems. On YouTube, type dr blake healing sole posterior tibial tendon and see what comes up. Rich

The top 10 treatments for tibial tendinitis/dysfunction/tear are:

1.  Understand the biomechanics of the posterior tibial tendon to support the medial longitudinal arch and begin to support the arch as part of all phases of the rehabilitation: Immobilization, Re-Strengthening, and Return to Activity.

2.  Start with OTC and advance to custom orthotic devices with maximal support (this is not an injury to settle with less than optimal support).

3.  Learn several different taping techniques: posterior tibial and circumferential arch.

 

4.  Ice the area 3 times daily for 15 minutes each.

 

5.  If possible, get a baseline MRI (may be an important comparison 6 months later).

 

6.  Most ankle braces hold the ankle pronated which is bad for this injury, consider an Aircast Airlift PTTD brace for times you are not using orthotic devices.

7.  Create an initial pain-free environment with below knee removable boot/cam walker, and perhaps a Roll aBout.

8.  If the injury is substantial (Grade 3-4 typically), have a hinged AFO custom-made at a brace shop right at the start of the injury (it can take a while to get fitted)

9.  Begin strengthening the posterior tibial tendon as quickly as possible with at least active range of motion exercises. The Posterior Tibial tendon is strengthened by pointing the ankle first and then moving the foot towards the other foot.

10. have a surgeon as part of the treatment.

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