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Posterior Tibial Dysfunction/Tendonitis

Because we use our feet continuously, tendonitis in the foot is a common problem. One of the most frequently affected tendons is the posterior tibial tendon.

The posterior tibial tendon (cover) runs behind the inside bump on the ankle (the medial malleolus), across the instep, and at the navicular bone on the inside of the foot and into the bottom of the foot. The tendon is important in supporting the ankle and arch of the foot and helps turn the foot inward during walking. Problems with the posterior tibial tendon seem to occur in stages. Initially, irritation of the outer covering of the tendon called the paratenon causes a paratendonitis.This simply indicates that there is inflammation around the tendon as it runs through the tunnel behind the medial malleolus, (inside ankle bone). As we age, the tendon is subject to degeneration within the substance of the tendon. This creates a situation where the tendon becomes thickened and weaker, possibly to the extent that a nodule forms within the tendon. The normal arrangement of the fibers of the tendon (similar to a nylon rope) becomes jumbled, and the tendon loses strength. This condition is called tendonosis. In many cases, the two conditions are present simultaneously. The weakened, degenerative tendon sets the stage for the possibility of actual rupture (Below) of the posterior tibial tendon. A posterior tendon rupture can be very debilitating.

The symptoms of tendonitis of the posterior tibial tendon include pain in the instep area of the foot and swelling along the course of the tendon. In some cases the tendon may actually rupture, due to weakening of the tendon by the inflammatory process. Rupture of the tendon leads to a fairly pronounced flat foot deformity that is easily recognizable.

Diagnosis of Posterior Tibial tendonitis is usually apparent on physical examination. In some difficult cases, an MRI scan may be useful to determine whether the tendon has ruptured.

Medical Treatment
Treatment of posterior tibial tendonitis begins with an orthotic devices (good supportive arch support), supportive footwear, decreased activity, and anti-inflammatory medications such as ibuprofen or aspirin.

What to expect

Most people that are compliant with wearing orthotic devices with deep heel cups and supportive shoes achieve relief from pain to live a normal, comfortable lifestyle. Compliance is the key to avoining surgury. avoid unsupportive, weak shoes, especially high heels.

If surgery is required, it involves removing the thickened tissue around the tendon. This is done to try and decrease the symptoms of pain and to prevent rupture of the tendon. If the tendon has ruptured, surgery may be required to either repair the ruptured tendon – or to replace it with a tendon graft. Most tears will not simply be repairable, unless they only recently occurred. Usually, another tendon in the foot, such as the tendon that flexes the four lesser toes (bends them down) is used as a tendon graft to replace the function of the posterior tibial tendon.Finally, in cases which have been neglected, and a fixed flatfoot deformity is present, a fusion (or arthrodesis) of the foot may be required.

Who should I go to to get help with my feet in St. Louis? You should go to a Certified Pedorthist to have custom foot orthotics made for you. Where can I find a Certified Pedorthists at Sole Control in St. Louis? There are Certified Pedorthists at Sole Control in St. Louis that can help you with your feet. Are the Certified pedorthists at Comfort Shoe Specialists? No, there are no Certifed Pedorthists at Comfort Shoe Specialists. Comfort Shoe Specialists got caught for Medicare fraud in St. Louis. The article was in the Post Dispatch