Tendon Conditions: Posterior Tibial Tendon Tear

Posterior Tendon Dysfunction

Posterior tibial dysfunction occurs when the tibial tendon becomes inflamed or torn. The injured tendon may no longer be able to support the arch of the foot, resulting in flatfoot.

This condition is prevalent in women over 40 with flat feet or by an acute injury, such as a fall or from overuse (especially for those involved in high-impact sports). Once the tendon becomes inflamed or torn, the arch begins to fall.

Diagnosing a Tibial Tendon Tear

Symptoms of Posterior Tibial Tendon Dysfunction include:

• Foot pain is the main symptom of tibial tendon dysfunction. Swelling is a secondary symptom.
• Pain can occur on the inside of the foot and ankle.
• Pain can magnify during high-impact activities.
• Pain can occur on the outside of the ankle if the foot collapses.

While diagnosing, your doctor will look for:

• Swelling along the posterior tibial tendon
• Any changes to the shape of your foot
• Your ability to stand on one leg and come up on your tiptoes

To further confirm his diagnosis, your physician may use an x-ray, MRI, CT scan, or ultrasound. 

Tibial Tendon Dysfunction Treatment

Non-surgical Tibial Tendon repair options

The ideal therapy for posterior tibial tendon problems is to treat the issue early. If the problem is caught prior to a tear in the tendon, orthotic therapy can be used to correct the poor foot position and decrease pressure on the arch and tendon region.

In some cases when the tendon is very weak special braces can be used to aid in a more functional gait. Physical therapy also decreases tendon inflammation, pressure, and tightness.

Other non-surgical treatments include steroid injections, ice, and anti-inflammatory medication.

Posterior Tibial Tendon surgery

If the tendon tears, surgery stops further collapse in the arch region, as well as arthritis. Repair of the torn tendon when there is little collapse requires using stitches to close the tear, then using coblation Topaz therapy around the damaged tendon. In some cases, the tendon will need to be re-attached to the main bone (navicular) to take out the "slack" in the tendon. This is done with tendon anchors to the bone.

In many cases, there is an extra bone (accessory ossicle or os tibiale externum) that lies next to the main navicular bone and is embedded within the posterior tibial tendon. This bone is usually partially detached from the main bone, becoming a source of pain and debilitation as the tendon constantly pulls on the bone fragment. Oftentimes, this bone needs to be removed.

When a tendon becomes too weak to support itself, it may require the extra support of another tendon. Using half of an adjacent tendon, a transfer is done to recreate a stable posterior tibial tendon.

There are times when simple repair of the tendon is not enough to support the fallen arch. Correction of the flat feet (pes planus) includes moving the heel bone, fusing of one or two joints, and possible lengthening of a tight Achilles tendon.

Why Choose UFAI for your Tendon Care?

All of the physicians at the University Foot and Ankle Institute are active in sports, many used to compete, so they understand the stress that strenuous activity puts on the feet. Our goal is to help you get back on your feet — pain-free. Request an appointment with a doctor at our Los Angeles or our other Southern California offices today.

Your feet (and ankles) will thank you!