Posterer tibial tendon

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Posterior tibial tendonitis is a relatively common problem of the foot and ankle. When this tendon becomes inflamed, it can cause severe pain along the inside of the ankle. A serious complication occurs if the posterior tibial tendon ruptures.

Diagnosis of posterior tibial tendonitis is commonly made by physical examination. Patients have tenderness and swelling over the course of the posterior tibial tendon. Usually they have weakness inverting their foot. Viewing the patient from behind, a physician will sometimes see the “too many toes” sign. Also common in patients with posterior tibial tendonitis is an inability to stand on their toes on the affected side because of pain.

When the examination is unclear an MRI or diagnostic ultrasound can be used to confirm the diagnosis.

Posterior tibial tendonitis and rupture are seen in many patients with long-standing rheumatoid arthritis.

Conservative treatment of posterior tibial tendonitis consists of special inserts for the shoe, walking boots, or even a short leg cast. The goal of these treatments is to rest the posterior tibialis muscle and decrease the inflammation around the posterior tibial tendon.

Other treatments for posterior tibial tendonitis include anti-inflammatory medications and activity modification.

Surgical treatment of posterior tibial tendinitis is controversial and difficult.

If the tendonitis is diagnosed prior to when the tendon is destroyed, a newer treatment for tendonitis may be more effective and prevent the need for surgery. Percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the tendon. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality tendon tissue is stimulated to grow with natural healing.

For more information about this procedure, visit our sister site:
Tendonitis provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

In patients with rheumatoid arthritis, it is important to ensure their medical program is aggressive enough to prevent further joint deterioration.

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