Optimizing Outcomes for Posterior Tibial Tendon Injuries

The posterior tibial tendon is the major tendon supporting the arch of the foot. Damage to this tendon can, (put in terms that our patients understand) cause arch collapse, sometimes to a major degree. Any sign that this tendon is having or beginning to have problems must therefore be fully addressed to avoid long-term issues. I find that this is one of the most common surgeries that my patients undergo because of the disability the condition can cause. I work long and hard on each one of these patients, either trying to avoid surgery (usually), or in their post-surgical rehabilitation.
 
In my experience, I find that there are a “Top 10” treatments for posterior tibial tendonitis/dysfunction/tear that help my patients the most:
 
1.     Understand the biomechanics of the posterior tibial tendon, and support the arch through all phases of rehabilitation, including immobilization, re-strengthening, and return to activity.
2.     Start with over-the-counter, and advance to custom orthotic devices with maximal support (this is not an injury to settle for less than optimal support).
3.     Learn several different taping techniques, including posterior tibial and circumferential arch.
4.     Ice the area 3 times daily for 15 minutes each.
5.     If possible, get a baseline magnetic resonance imaging (MRI) study. This may prove an important comparison 6 months later.
6.     Most ankle braces will allow for overpronation, which is bad for this injury. Consider a brace such as the Aircast Airlift PTTD brace for times the patient is not using an orthotic device.
7.     Create an initial pain-free environment with a below-knee removable cast boot walker, or perhaps a wheeled knee walker.
8.     If the injury is substantial (grade 3-4, typically), have a hinged AFO custom-made at a brace shop early in the injury (this process can take a while).
9.     Begin strengthening the posterior tibial tendon as quickly as possible with at least active range of motion exercises.
10.  If you do not personally perform surgery, make sure you have a foot and ankle surgeon as part of your team should this become necessary.

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com.

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.

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