Posterior Tibial Tendonitis
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Posterior Tibial Tendonitis is a common condition that affects the inner ankle and medial arch of the foot. In this article, we will cover the differential diagnosis between Posterior Tibial Tendonitis and other conditions of the foot and ankle.
Posterior Tibial Tendonitis affects the posterior tibial tendon that is located on the inner side of the shin, reaching down and behind the medial malleolus and onto the medial arch of the foot while Plantar Fasciitis effects the Plantar Fascia. The Plantar Fascia is located on the underside of the foot, attaching from the heel bone and spreading out like a fan across the under side of the foot and attaching to the forefoot.
Both conditions are caused by overload of the individual structure and there is some cross over in the location of pain making differential diagnosis difficult. The most common location of pain for the Posterior Tibial Tendonitis is along the inner ankle however there can be pain on the attachment of the tendon onto the medial foot. When this occurs it referred to as an enthesopathy rather than tendonitis. Plantar Fasciitis is often most painful on its attachment to the inner heel bone although there can be pain on the mid portion around the medial arch of the foot.
Both conditions are painful first thing in the morning, made worse with activity and improve when rested. Differential diagnosis can be achieved by a clinical examination alongside an ultrasound scan.
Posterior Tibial Tendonitis is a condition of the Posterior tibial tendon where pain is commonly located on the inner ankle and medial arch of the foot. Achilles Tendonitis is a condition effecting the mid-portion of the Achilles Tendon which is location on the back of the ankle, attaching the calf muscle complex to the heel bone.
There can be some crossover between both of these injuries, especially if there has been a mechanism of injury such as a medial ankle sprain. This usually occurs when there is a sudden eversion of the ankle joint that over stretches and tears the ligaments on the inner ankle. These ligaments are known as the deltoid ligaments. With a significant Deltoid ligament tear, the Posterior Tibial Tendon can also be over stretch, causing pain, inflammation and eventually tendonitis.
Secondly, a mild ankle sprain can lead to antalgic gait pattern. This can overload other aspects of the foot and ankle such as the Posterior Tibial Tendon, leading to Posterior Tibial Tendonitis. Finally, if there is not mechanism of injury, it is unlikely to be a sprained ankle and a higher likliehood that your inner ankle pain is the result of Posterior Tibial Tendonitis.
Clinical evaluation of the deltoid ligaments will be able sufficient to ascertain if there has been an injury to them while pain along the tendon on palpation alongside pain on resisted inversion is indicative of possible Posterior Tibial Tendonitis.
Posterior Tibial Tendonitis and stress fractures to the medial malleolus or the navicular bone can cause some confusion.
Stress Fractures are often the result of a trauma such as a fall, awkward landing or something falling onto the bone. However, there can occur insidiously in people with low vitamin D levels, Osteopenia or Osteoporosis.
Taking this into account some of the key differences are that Posterior Tibial Tendonitis is normally worse first thing in the morning, worse after activity but improves with rest whereas a stress fracture is consistently painful with use.
The Tarsal tunnel is a a small groove on the inner ankle that contains blood vessels, nerves and some fatty tissue. If this becomes irritated through trauma or a biomechanical overload it often presents with inner ankle pain when walking, numbness or pins and needles on the inner aspect or top of the foot.
Posterior Tibial Tendonitis can provide pain with use on the inner ankle and along the medial arch of the foot during or after us but unlike Tarsal Tunnel Syndrome it does not provide any neurological symptoms.