You rely on your ankles for more activities than you probably realize. At least, you might not realize it when your ankles are healthy. If you are suffering from ankle pain, it can be easy to see how much you use these valuable joints, for everything from walking and running, to driving your car and even simply standing.
If there is pain on the inside of the ankle that extends to the arch, this could be a case of posterior tibial tendonitis. Let’s take a closer look at this tendon, how it affects you, and what we can do about it for you.
It is difficult to overstate the importance of your ankle joints, but easy to take for granted the way they are intricately-structured to perform well. To start with, there are actually two separate joints that are often collectively known as the “ankle joint.” The “true ankle joint” is located where the 2 leg bones (tibia and fibula) meet the talus (ankle bone). The other joint is underneath the talus that sits on top of the calcaneus (heel bone). These two bones form the “subtalar joint.”
The true ankle joint enables the foot to move up and down, whereas the subtalar allows for side-to-side movement.
The respective joints are supported and held together with ligaments that connect the bones together, and tendons—including the posterior tibial tendon— that connect muscles to bones. The posterior tibial tendon is particularly important. It starts in the lower leg next to the calf muscle, goes down the leg to the inside of your arch, and stabilizes the foot. It limits too much pronation, and prevents the foot from collapsing. Pronation is the natural inward rolling motion performed by your foot with every step you take that acts like a shock or strut in a car. This tendon will become stretched and torn if it has to do more work that it is intended to do.
Tendonitis is a term we use for a tendon that has become inflamed, often from overuse (too much unprotected activity or too great of body mass). The posterior tibial tendon’s job is to slow down and stop 2 x your weight at the end of EVERY step.
Symptoms can include pain, especially along the inside of the ankle and at the arch over the Navicvular bone. Symptoms get worse with activity. In chronic cases, pain may develop on the lateral/outside joints of the ankle.
When the heel bone shifts or tilts towards the outside, it is typically the result of a collapsed arch (posterior tibial tendon dysfunction). The posterior tibial tendon plays a vital role in supporting the foot arch. When the tissue becomes elongated or stretched, it loses its ability to properly hold up the arch.
Signs that we will look for when diagnosing this condition include: a collapsed arch, the heel tilting outward, pain and swelling on the inside of the foot and ankle (where the posterior tibial tendon is located), looking at the foot from behind and seeing “too many toes,” and weakness and pain when a patient raises the heel up while standing on one foot.
Although Diagnostic imaging tests that can be used to confirm the condition, X-rays, MRI, CT scans, and ultrasound, this is generally a clinical call. These types of tests are useful in determining the extent of tearing and joint damage if surgery is required.