Tibalis Posterior Pain Explained

Are You Experiencing Medial Ankle Pain When Jogging? – City Physiotherapy explains Tibialis Posterior Pain

Tibialis Posterior (Tib Post) pain is a common running injury that can cause flat feet and foot problems in later life. The Tib Post tendon can become inflamed, partially torn or ruptured, causing pain behind the bony prominence on the inside of the ankle. Tib Post tendon problems usually occur gradually over time due to overuse in runners. It can also be caused by a direct hit such as in a football or soccer game.

The Tib Post muscle originates from the back of your shinbone travels along the inside of your ankle as a tendon then inserts into the toe bones in the middle of the foot. In conjunction with two other tendons (Flexor Hallucis Longus and Flexor Digitorum Longus) the Tib Post passes just behind the bony prominence (malleolus) on the inside of the ankle and this is often where the pain is felt.

The purpose of your Tib Post muscle is to help your calf muscles push your foot down, in the ‘toe off’ phase of walking and running and also to turn your foot inwards. If your heel turns outwards at the bottom this will cause your foot to roll inwards (pronate). This creates greater strain on your Tib Post tendon predisposing it to injury.

This pain can also arise without poor foot biomechanics, especially if you have done a lot of running around tight corners or on a road with a camber. Often this doesn’t occur after one run – it is the result of repeated overuse – with every step that you take your tendon is overloaded, irritated and becomes inflamed. The result is the inside of your ankle becomes extremely painful.

Because your Tib Post tendon plays an important role in providing support to the arch on the inside of your foot, it functioning correctly is pretty important. If ignored, and you carry on running (like most of us want to do) it can lead to a complete rupture of the tendon requiring surgical repair. This will have a major effect on your foots biomechanics with the inside arch of the foot losing it’s support structure and ‘collapsing’. At City Physiotherapy we can’t stress enough that seeking treatment early is very important.

Tibialis Posterior Pain Treatment

What you can do

In the initial stage, the P.R.I.C.E protocol should be followed

P – Protection

R – Rest

I – Ice

C – Compression

E – Evaluation

Following the PRICE protocol will help combat the inflammatory process within the Tib Post tendon sheath. Ice Packs applied for twenty minutes every two hours can relieve pain and Non Steroidal Anti Inflammatory Drugs (NSAIDs) may be helpful at this stage. Applying an Anti Inflammatory Gel can also assist Tib Post symptoms. Dry Needling and Physiotherapy will also be aimed at reducing inflammation in the tendon in the acute pain phase.

At City Physiotherapy & Sports Injury Clinic we will assess and treat any abnormal lower leg biomechanics, which are usually involved in Tib Post tendon problems. Sometimes a period of complete rest to reduce inflammation is also required. It is not just a case of returning to running once your pain has subsided. Your physiotherapist will work with you to develop improved muscle control of your foot and lower limb to prevent a reoccurrence. Even if you don’t have pain now a biomechanical assessment and exercise plan can be performed to address any muscle imbalances as part of your running Pre-hab.

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