What is tibialis posterior dysfunction?
Tibialis posterior is a muscle in the lower leg. Its tendon attaches the muscle to bones in the foot. The tendon is one of the major supporting structures of the foot maintaining the arch of the foot and helping the function of the foot whilst walking. Tibialis posterior dysfunction is a condition which causes changes to the tendon impairing its ability to support the arch of the foot resulting in a gradual flattening of the arch.
It usually only affects one foot but some people may develop it in both feet. It is usually progressive meaning it will gradually get worse and worse particularly if it is not diagnosed and treated in the early stages.
What causes tibialis posterior dysfunction?
Overuse of the tendon is the cause of tibialis posterior dysfunction. Activities that cause the dysfunction are activities that require the use of the muscle such as walking, running, climbing stairs and hiking.
What are the symptoms of tibialis posterior dysfunction?
The symptoms will vary depending on how advanced the condition is. The main symptoms are pain, swelling, a flattening of the arch and a rolling inwards of the ankle. In the early stages the pain is usually felt along the course of the tendon so is felt along the inside of the foot and ankle. There may also be swelling, a redness and heat present along the inside of the ankle and foot. As the condition progresses the pain is usually still felt on the inside but the arch starts to flatten and the toes turn out and the ankle rolls inwards. As the condition advances further the arch flattens more and the pain is now often felt o the outside of the foot below the ankle. Arthritis (wear and tear) often also develops in the foot and sometimes in the ankle in more severe cases.
Diagnosis of tibialis posterior dysfunction
A though subjective questioning and objective assessment by your physiotherapist will enable them to make a diagnosis of tibialis posterior dysfunction. Due to the complexity of the foot and ankle region consisting of many different bones, ligaments, muscles, tendons, nerves and blood vessels, a thorough assessment by a qualified physiotherapist is essential to aid correct diagnosis and therefore appropriate and timely treatment to promote fast recovery. The assessment is likely to include some or all of the following; observation of stance and gait, ankle and foot range of motion and flexibility, strength, palpation and specific special tests to rule out other diagnoses.
Physiotherapy treatment for tibialis posterior dysfunction
The treatment will depend on the stage of the condition and severity and will be tailored to your needs and assessment findings. The treatment will include some or all of the following:
- Advice and education
- Gait re-education
- Electrotherapy (ultrasound)
- Soft tissue mobilisations
- Joint mobilisations
- Balance and proprioception
- Specific home exercises to improve strength, flexibility and function
When to seek help from a physiotherapist
Physiotherapy treatment is most effective the earlier the condition is picked up since it is a progressive condition. It is therefore advisable to seek help as soon as possible from a physiotherapist so that your symptoms may resolve without the need for invasive treatment. If conservative treatment (physiotherapy, orthoses, medications) is not effective then surgical treatment is the next step. Untreated tibialis posterior dysfunction can result in a flat painful foot with arthritis in the foot and ankle causing major limitations to weight bearing activities.