Painful Progressive Flatfoot, otherwise known as Tibialis Posterior Tendonitis, occurs when the tendon of the tibialis posterior becomes inflamed, stretched or suffers a partial or total tear. If left untreated, this condition may lead to severe disability and chronic pain.
A look at anatomy…
It’s always a good thing to understand just a bit of anatomy when talking about tendonitis. The tibialis posterior muscle begins just below the back of the knee and runs along the back of the leg. The tendon then passes under the inner aspect of the ankle and attaches at the inside of the midfoot or arch area. This tendon is responsible for helping to maintain the arch in the foot while the muscle aids in lifting the heel off the ground when you walk. Medical jargon aside, it’s extremely important to your movement!
What are the symptoms?
If your tibialis posterior tendon is inflamed or partially torn, then you’ll feel pain from the inside of the ankle to the arch area.
If you have a more severe injury, you might feel a swollen, or bulbous, area along the inside of your ankle.
If a sudden fall in your arch occurs, this may cause a complete rupture of your tendon which will produce severe pain. You’ll notice that the pain is usually worse while walking and especially while rising up on your toes. Walking up and down stairs may also be very painful. If any of these symptoms are familiar to you, we suggest you come in for an immediate consultation.
How We Go About the Diagnosis?
We’ll first take a complete history and perform a thorough physical. We’ll examine the involved foot by palpating the area for pain and swelling while looking for a “too many toes” sign when the foot is viewed from the back.
Then we’ll compare the arch of the uninvolved foot to the involved foot, looking for discrepancies. We’ll evaluate muscle and tendon strength by having you move your foot against resistance.
An X-ray will also be taken to evaluate any bony problems along the course of your tendon. We may also need an MRI to identify the extent and specific location of the damage to your tendon.
Treatment is on the way…
We’ll first take a conservative route of treatment, which includes the use of nonsteroidal anti-inflammatory medications, ice, physical therapy, supportive taping and bracing or orthotic devices. We may also utilize leg and foot casting in more severe cases.
In some instances, where conservative treatment isn’t relieving you pain, we may recommend surgery. Surgery for this condition involves repairing the torn or damaged tendon to restore normal function.
To prevent reinjury, we might prescribe orthotic devices. In severe cases, we might find that surgery on the midfoot bones is necessary to treat the associated flatfoot condition.
