Posterior Tibial Tendinitis, Posterior Tibial Rupture

One of the most frequently affected tendons is the posterior tibial tendon.

Anatomy

The posterior tibial tendon courses behind the medial malleolus, across the instep, and into the bottom of the foot. The tendon supports the instep of the foot.

This tendon is prone to rupture. Initially tendonitis and swelling around the tendon sets . In later stages this gets attenuated and finally undergoes attrition tear.

The symptoms of tendinitis of the posterior tibial tendon are pain in the instep area of the foot and sausage shaped swelling along the course of the tendon. Rupture of the tendon leads to a fairly pronounced flatfoot deformity.

Treatment of posterior tibial tendinitis begins with a good supportive arch support, decreased activity, and anti-inflammatory medications such as ibuprofen. Sometimes an ankle foot orthosis (AFO) helps. Surgery is used to excise the inflamed synovium off the tendon.

If the tendon has ruptured, surgery may be required to either repair the ruptured tendon or to reconstruct it with a tendon transfer. Usually, another tendon in the foot, such as the tendon that bends the four lesser toes, is used as a tendon graft to replace the function of the posterior tibial tendon.

In late diagnosed cases bony surgery such as cutting the heel bone and shifting it to make the foot more straight is required.

Finally, if the foot has severe deformity with arthritis, a fusion (or arthrodesis) of the foot may be required. A fusion is an operation where a joint between two bones is removed and the two bones on either side of the joint are allowed to grow together, or fuse. This type of operation is used to stop pain from joints that are worn out and can be used to realign the bones when the normal mechanisms for maintaining normal alignment are deficient, such as when the tendon and ligaments no longer work properly.

Following surgery, a cast and/or a brace is worn for 8 to 12 weeks.