Sports Medicine: Posterior Tibialis Tendonitis

Posterior tibialis tendonitis is an injury of the posterior tibialis tendon in the back of the inner ankle. This tendon connects the muscles of the leg to the inner foot. It is important for standing on the toes, the pushing-off phase of running or jumping, and in turning the foot inward (inversion).

Signs and Symptoms

• pain, tenderness or swelling over the back, inside part of the ankle
• pain with standing on the ball of the foot or when the foot is flexed
• pain with ankle motion, especially when pushing off or pushing down with the front of the foot
• a cracking sound when the tendon is moved or touched

Increased Risk

• sports that require sudden, repetitive jumping and quick starts, or kicking and running sports, especially running hills and long distance
• poor physical conditioning (strength and flexibility)
• flat feet
• previous injury to the foot, ankle, or leg

Treatment

• Medicine
  • Anti-inflammatory medicines, such as ibuprofen (Motrin^® or Advil^®) or naproxen (Aleve^®) may be recommended. Take these as directed by your health care provider.
  • Other minor pain relievers, such as acetaminophen (Tylenol^®), may be used.
• Use of cold and heat
  • Cold should be applied for 10 to 15 minutes every 2 to 3 hours and after any activity that makes symptoms worse. Use ice packs or an ice massage.
  • Heat should not be used on a new injury but may be used before performing stretching and strengthening activities prescribed by your health care provider or athletic trainer. Use a heat pack or a warm soak.
• Rest
  • Rest or decreased activity should help decrease pain and swelling.
• Orthopedic aids
  • A cast or walking boot may be used in severe cases to limit activity and improve pain.
  • A heel lift or arch support (orthotic) may be used in some cases.
• Rehab
  • Rehab with a physical therapist or athletic trainer can increase flexibility and strength, decrease pain and help the athlete return to activity.

How to Prevent

• Do correct warm-up and stretching before practice or competition
• Use proper technique
• Allow time for ample rest and recovery between practice and competition
• Maintain ankle and leg stability, muscle strength and endurance
• Wear arch supports for flat feet
• Complete rehab from a previous injury

When to Call the Health Care Provider

Call your health care provider or the Sports Medicine team at 614-355-6000 if:

• symptoms get worse or do not improve after 2 to 4 weeks of treatment
• new, unexplained systems develop

Posterior Tibialis Tendonitis (PDF)

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