Condition Spotlight: Tibialis Posterior Dysfunction

Have you got flat feet or know someone with flat feet?

Or perhaps, over time, your feet have become flat!

This could be because of the tibialis posterior muscle not functioning to the best of its ability.

Also referred to as adult acquired flat foot, tibialis posterior dysfunction can cause pain in both the foot and the ankle.

What is the tibialis posterior muscle and how does it work?

The tibialis posterior is made up of a muscle and tendon.

The muscle sits behind the shin bone (tibia) and is located near the calf muscle and the tendon runs down the leg, behind the medial aspect of the ankle and into the arch of your feet.

Its role is to help to support the arch of your feet, invert the heel, and help your ankle move in an upwards motion (plantarflexion).

Dysfunction of the tibialis posterior tendon results in the flattening of the arch of the foot and is more common in adults.

When the tibialis posterior is unable to work correctly, the surrounding ligaments and bones on the inside of your foot become weak and can contribute to flattening of the arch.

What does tibialis posterior dysfunction feel like?

Dysfunction of tibialis posterior can have the following symptoms:

• Noticeable redness and or swelling on the inside of your ankle and foot that is tender to touch.
• Pains and aches along the inside of your foot and ankle that worsens during high impact activities like running and playing sports like netball, basketball and many more.
• You might be able to pinpoint the exact moment during walking that you can feel pain and discomfort.
• You may notice that when you walk your toes are pointing outwards and your ankles roll inwards.

In more severe cases of tibialis posterior dysfunction such as a tear or rupture, the pain is much worse and leads to not being able to weight bear correctly through your foot.

What causes tibialis posterior dysfunction?

Flat feet, also known as a pronated or pes planus foot type, can be caused from a range of factors such as genetics and anatomy.

When the feet are in a pes planus alignment, this places more stress on the tibialis posterior tendon when walking, running or being active.

Repetitive loading and overuse of the tendon leads to weakening of the tibialis posterior tendon and can therefore causing pain through the inner ankle or arch.

When this happens, your body will start to use other muscles and tendons in the lower leg and foot to compensate for the weakened tibialis posterior.

Additional reasons for tibialis posterior dysfunction include tearing of the tibialis posterior tendon, repetitive rolling of your ankles and or damage to the arch ligament (spring ligament).

Who does it affect?

This condition affects the following populations:

• Females over the age of 40
• People with the following conditions such as hypertension, diabetes and or obesity
• If you have had previous surgery to your foot or ankle

How is tibialis posterior dysfunction diagnosed?

History taking

• Gaining an understanding of your relevant history helps us in diagnosing posterior tibial dysfunction. Relevant information includes previous injuries to your feet or leg; surgeries to your foot or leg; activity levels; medical history; the type of pain such as an ache, burning, tenderness or sharp pain; and/or if you have experienced this pain before.

Biomechanical assessment

A Foot Posture Index is used to score your foot as either having high arches (supinated), neutral or flat feet (pronated). This test observes your feet in standing position and scored accordingly.

• A few of the key things we look for are:
  • The position on your heel when standing. 
  • Is there a bump or bulge in your arch?
  • Which toes can we see when looking at the back of your foot.
  • The direction of your achilles tendon.
• Testing the strength of your lower limb muscles, especially the tibialis posterior muscle, can assist us in identifying if there is a weakness of this tendon. This is completed by getting you to do a double leg calf raise and a single leg calf raise as this exercise works the tendon and muscle. When there is weakness or dysfunction of the tibialis posterior tendon, a single leg calf raise can be difficult to complete correctly.
• Checking for any restriction or limited range of motion in joints like your ankle and midfoot is important, as this is linked with the way that your foot functions. Restriction of your ankle and the midfoot is common amongst people with this condition and is a key part in developing our diagnosis.
• We also observe the way that you walk to allows us to see how your foot works on a day-to-day basis. This is helpful for us to see if there is a noticeable collapse of your arch when you walk, the position of your toes when you walk and look at your heels too.

Imaging

• We use x-ray and ultrasound imaging to assist us in accurately diagnosing your conditions, these images help us determine the extent of the condition, whether other structures are involved or damaged and how to approach your treatment plan.

How is tibialis posterior dysfunction treated?

Treatment available for tibialis posterior dysfunction are.

• Footwear

Changing shoes can be a massive help to reducing your pain. Wearing flat soled shoes with little to no support through the arch of your feet puts more pressure on your tibialis posterior tendon. We recommend wearing good supportive footwear daily as this is extremely important for management of this condition. For extra information on shoes visit our blog here for everything you need to know about shoes.

• Taping

Using tape can help provide pain relief to the tendon and muscle by supporting the arch of your foot and taking some of the pressure off the posterior tibial tendon. We are able to use tape to support your foot during exercise and sports as well as simulating the effects of orthotics.

• Orthotics

Orthotics are great for conservative treatment for tibialis posterior dysfunction. They work by correcting the position of your foot and giving you an arch. Orthotics are beneficial in reducing the work needed to be done by the tibialis posterior tendon and if treated early enough, prevent further damage to the foot. Here at Watsonia Podiatry we use custom foot orthotics to assist us in the treatment of your foot related issues, for more information on our orthotics click here.

• Calf raises

This involves standing on either one or two legs and pushing up onto your toes. This exercise aims to build calf strength, improve foot function, and limit the work of the tibialis posterior tendon. As you progress from bodyweight only exercises, we will start to add more load through the muscles to continue strengthening and improve foot function.

• Theraband exercises

Therabands are great for providing resistance on the muscles and tendons and are used to strengthen specific areas of the leg and foot. When using it for tibialis posterior exercises, the aim is to move your foot inwards towards the centre of your body and hold as seen in the picture here, doing this movement targets the tibialis posterior tendon.

• Surgery

In severe cases where the tibialis posterior muscle or tendon is damaged, torn, or the bones of the midfoot where it attaches to are also damaged, surgery may be required. This may involve repairing the tendon or moving its attachment.

If you’re experiencing any pain or discomfort that sounds like what we’ve talked about to day, or any other pain in your feet or lower limbs, come see us at Watsonia Podiatry. We can help you get your feet back on track.  Book online here or call us on 03 9432 2689 for your appointment.