Does the inside of your leg hurt too? Let's learn about (Posterior Tibial Tendonitis) and (Posterior Tibial Tendon Dysfunction)!

Our feet are very important things that we use all day long, supporting our entire weight, right? But sometimes these feet can get a little sore. Have you ever noticed that you have pain on the inside of your foot, near your ankle? Maybe this pain increases when you walk, run, or climb stairs. Many people may not pay much attention to this, thinking, "It will be fine in a few days." But if this continues, it can become a little more serious. Today we are going to talk about a condition that can cause such leg pain.

What is Posterior Tibial Tendonitis?

Simply put, Posterior Tibial Tendonitis is an inflammation or swelling of the Posterior Tibial Tendon, which supports the arch of your foot and helps you bend your leg. It is also called the Posterior Tibialis Tendon .

Now you're probably wondering what a tendon is. A tendon is a strong, rope-like tissue that connects our muscles to our bones. So, the posterior tibial tendon connects a muscle in our lower leg to the bones on the inside of our leg.

When this tendon becomes inflamed , you may feel pain and tightness along the arch of your foot, on the inside of your foot, or in your ankle. This inflammation of a tendon is medically called tendinitis . It can be short-term (acute) or long-term (chronic).

If posterior tibial tendinitis continues, that is, if it goes on for a long time without healing, the tendon gradually weakens and begins to break down. We call this condition tendinosis . This posterior tibial tendinosis is what leads to a condition called Posterior Tibial Tendon Dysfunction (PTTD) .

So what is posterior tibial tendon dysfunction (PTTD)?

Posterior tibial tendon dysfunction (PTTD) occurs when the tendon breaks down and weakens due to the chronic tendinosis of the posterior tibial tendon mentioned earlier. When the tendon weakens, it can no longer support the arch of your foot.

Do you know what this causes? Your feet start to become flat and your ankles start to turn inward. You may feel your arches and ankles are very weak, especially when you try to lift your heels. If this condition continues, it can gradually become worse.

Doctors also call this condition Posterior Tibial Tendon Insufficiency (PTTI) . PTTD is the leading cause of progressive collapsing foot deformity (PCFD), a condition previously known as adult-acquired flatfoot or "fallen arch ."

Imagine, when the arch of your foot collapses, the way your foot strikes the ground when you walk, and therefore the way it bears weight, changes. This can eventually damage other parts of your foot, such as the ligaments and eventually the cartilage.

What are the stages of this condition? (Stages of Posterior Tibial Tendinopathy)

Doctors classify this into several stages depending on your condition:

• Stage 1: This is mild tendonitis and/or tenosynovitis (swelling of the sheath around the tendon). There is no significant change in the structure of your leg. You can still lift your heel, but you may experience some pain when doing so.
• Stage 2: At this stage, you can no longer lift your heel. X-rays show that your arch has collapsed, but it is still flexible and not stiff. Your toes may be starting to spread out a little. (Doctors call this the "too many toes" sign . This means that when you look at your foot from the back, you can see more toes than you normally would.)
• Stage 3: By now your arch has completely collapsed and become rigid. Both your toes and heels are pointing outwards. You may also be showing signs of arthritis in the subtalar joint at the back of your foot.
• Stage 4: All of the above symptoms are present at this stage. X-rays also show that the deltoid ligament and talus bone in your ankle have shifted out of place. You may also have signs of arthritis in your ankle joint.

What are the symptoms?

When you have Posterior Tibial Tendonitis, you feel pain along the path that the tendon runs, starting from the back of the ankle and running down the inside of the leg, all the way to the back of the bony prominence in front of the arch.

This pain can be felt especially during or after activities such as walking, running, or climbing stairs. In the beginning, the pain may be intermittent. But as the condition worsens, the pain may become more frequent.

Other symptoms of posterior tibial tendinitis may include:

• Swelling along the tendon, especially on the inside of the ankle.
• Pain when pressed with the hand, especially when bending the leg.
• Feeling of weakness in the leg or ankle, especially when "pushing off".

When tendonitis turns into tendinosis, you may find it increasingly difficult to use your leg, and the pain may spread. Eventually, you may notice physical changes in your leg such as:

• Collapse of the arch (flat foot).
• Ankle rolling inward.
• Heel and/or toe turning outward.

These are the symptoms of posterior tibial tendon dysfunction (PTTD).

What are the causes of this? (Posterior Tibial Tendinitis Causes)

Injuries are usually the main cause of tendonitis . When it comes to tendonitis in the legs, repetitive strain injuries are the most common. All of us, whether we are athletes or not, use our legs all the time.

When any tendon is overused, it becomes stressed, causing small tears in the delicate fibers. These take a long time to heal. Swelling is a sign that it is trying to heal. But if you don't give it a chance to heal, it won't heal.

Sometimes, your posterior tibial tendon can tear (acute injury) due to a sudden injury, such as a sports accident or a twisted ankle. If this tear does not heal completely, the temporary inflammation (acute inflammation) can become chronic.

Sometimes, if you have an abnormal walking gait, it can also cause repetitive strain on the tendon. For example, if your foot turns inward or outward, or if you have flat feet or high arches, even walking normally can put pressure on the tendon.

What are the risk factors?

There are several risk factors that can contribute to strain and swelling in your tendon:

• Weakness in the leg or ankle due to previous surgeries or injuries.
• Engaging in high-impact sports without good technique is called over-training.
• Standing for long periods of time without good supportive shoes. Consider that some jobs require standing all day (e.g., teachers, store workers). People like these are at greater risk if they don't wear proper shoes.
• Carrying excessive weight while walking. That is, obesity can also affect this.
• Having had abnormalities in the legs or the way they walk from the beginning.
• Having pre-existing osteoarthritis in the leg.
• Having an inflammatory connective tissue disease that causes swelling, such as rheumatoid arthritis .
• Tenosynovitis is an inflammation of the synovial membrane around your tendon.

How does tendinitis become PTTD?

Tendonitis and tendinosis can be like a vicious cycle. Chronic inflammation weakens the tendon, making it more susceptible to injury. Repeated injuries weaken the tendon further, and the inflammation continues.

As the tendon loses its effectiveness, other structures in your leg and ankle have to fill the gap. This extra pressure causes those structures to gradually fail, putting the burden back on the tendon.

What complications can occur in this condition?

Acute posterior tibial tendonitis can heal with rest and time. However, if the tendonitis becomes chronic, it can start a cycle of tissue degeneration. Ultimately, it can lead to posterior tibial tendon dysfunction (PTTD).

Posterior tibial tendon insufficiency can cause the arch of your foot to gradually collapse ( progressive collapsing foot deformity, PCFD , or adult-acquired flatfoot ). This can lead to additional complications.

When you walk on flat feet, the ligaments and eventually the bones in your foot move out of place. This causes further foot deformities. These deformities put pressure on your joints, which can lead to foot and ankle arthritis.

Another possible complication is complete rupture of the tendon. Because the tendon gradually weakens, it is more likely to rupture completely with a sudden injury. A completely torn tendon will require surgery to repair.

How do doctors diagnose this?

Conditions affecting your posterior tibial tendon (tendinopathy) can usually be detected with a physical exam. A doctor will examine your foot and ankle while you are standing and moving your foot in different ways.

They will feel around the tendon to see if it is swollen, press on it to see if there is any pain. Then they may do imaging tests, such as an X-ray or ultrasound, to look at your condition in more detail.

What are the treatments?

In early cases, posterior tibial tendonitis can be treated with simple treatments such as rest, ice, and over-the-counter medications. In more severe cases, a cast or boot may be required for a few weeks.

Conservative treatments for PTTD include physical therapy and the use of special orthotics — inserts that you wear inside your shoes — to reduce the pressure on the tendon when you walk. In very severe cases, you may need surgery to repair your foot.

At each stage, doctors will start with simple (nonsurgical) treatments first. They will consider surgical treatments only if your symptoms do not improve after several months of these treatments.

How long does it take to recover? (Recovery Time)

Acute tendinitis can heal in a few weeks. However, if you have tendinosis and tendon dysfunction, it will take longer. With simple treatment, it can take about three to four months to fully heal.

If conservative therapy doesn't work after a few months, your doctor may recommend surgery. After surgery, it can take another two to four months for your tendon to rehabilitate.

What happens if you have PTTD? (Prognosis)

The outlook for PTTD depends on the stage of your condition and the type of treatment you need. In the early stages of the disease, most people can make a full recovery with simple treatments.

If you have surgery to reconstruct parts of your leg, it's hard to predict the outcome. The surgery can be complex, and you may need to do more than one procedure. Even after surgery, some side effects may last for a while.

Can this be prevented? (Prevention)

Taking care not to overstress your tendons can help prevent tendinitis and tendinosis. If you know you're going to be doing a lot of work on your feet, be sure to wear supportive shoes , and then get plenty of rest.

If you start to feel pain in your tendon, take care of it, give it rest and let it heal. If the symptoms persist, see a doctor. He or she will tell you if you have tendinitis and what to do.

If you are diagnosed with tendinitis or tendinosis, it is very important to follow your doctor's instructions. Not giving your tendon a chance to heal properly will only prolong your symptoms and recovery time.

Finally, things to remember

Posterior tibial tendon dysfunction (PTTD) occurs when tendinitis and tendinosis persist for a long time. Some people may not notice the symptoms at first. But once you do experience symptoms, it's important to get them treated.

We all rely so much on our feet that sometimes we don't even think about them. When a foot hurts, you might think, "Well, that's just something you'll get through in life." But you'd be surprised how important a small tendon in your foot is.

Tendons are strong things, but they are slow to heal when injured. If they don't heal, they can wear away due to prolonged swelling. If your posterior tibialis tendon fails, the entire structure of your leg can collapse.

The bottom line is, take your pain seriously . The sooner you get proper treatment for posterior tibial tendinitis and posterior tibial tendon dysfunction, the smoother your recovery will be.

It can take a while to heal, especially if you have to have surgery. It's frustrating to have to stop everything because of a small tendon. But if you can think of this small tendon as a helper for the work it does for you every day, it will help you.

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