Pain on the inside of the foot and ankle joint when walking can be caused by inflammation (tendonitis) or a partial tear of the posterior Tibialis tendon. The Posterior Tibialis tendon is located on the inside of the ankle joint, where it circles the inside ankle bone before it attaches to the Navicular bone of the inside arch of the foot. The function of the tendon is to stabilise and maintain the medial arch of the foot. The tendon is aided in this role by the surrounding Flexor Hallucis Longis and Flexor Digitorum tendons and the medial spring ligament. The Posterior Tibialis Tendon can become inflamed and painful when walking or standing due to abnormal weight-bearing pressure from mechanical mal-alignment that exceeds the tensile strength of the tendon. This type of injury usually affects older adults. An acute tear to the tendon can occur during sport when an athlete stubs their foot on the playing surface.
Cause of Tibialis Posterior Tendonitis:
• Poor footwear
• Leg length difference between both legs, abnormal Q-angle between pelvis and the knee.
• General muscle tightness in lower leg and pelvic muscles with poor flexibility
• Walking or running on bumpy or uneven roads
Pain is felt along the Yellow Line
Signs and symptoms:
• Pain and discomfort on the inside of foot and ankle joint (see attached illustration)
• There may be swelling and a cracking or crunching sensation on the inside region of the foot
• Pain is aggravated by walking or standing. Running is very difficult causing persistent pain thereafter
• Pain can appear on the outside area of the ankle due to the collapse of the medial arch causing a change in mechanics of the foot when walking. Hence, this pain new outside ankle pain is brought about through incorrect supination of the foot
• Collapsed inside (medial) arch with the heel tilting inwards
• Instability when attempting to stand on one leg and toe raise
Treatment and management:
Rest the foot from all walking and apply cold therapy for the acute stage to help reduce inflammation. When treating this condition in my clinic, I would administer graded manual soft tissue treatment to the proximal tendon above the site of pain coupled active stretching in order to allow collagen production and remodelling to occur within the tendon. The treatment and rehabilitation would then progress to graded eccentric strength loading of the muscle. The underlying causes of the injury mentioned above, should also be addressed.
Tomás Ryan (BSc. (AHS), Ph.Th. MIAPT) is a registered physical rherapist with The Irish Association of Physical Therapy (MIAPT) and is based in Clonmel and Thurles.
Contact Number: 0504 26672
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