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Posterior Tibial Tendonitis Differential Diagnosis

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Posted 10 months ago


Last updated: 03/12/2022


by James McCormack

Posterior Tibial Tendonitis Differential Diagnosis

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 vs Plantar Fasciitis

Posterior Tibial Tendonitis affects the posterior tibial tendon located on the inner side of the shin, reaching down and behind the medial malleolus and onto the medial arch of the foot. In contrast, Plantar Fasciitis affects 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 underside of the foot and attaching to the forefoot.

An overload of the individual structure causes both conditions, and there is some cross-over in the location of pain, making differential diagnosis difficult. The most common location of pain for Posterior Tibial Tendonitis is along the inner ankle. However, there can be a pain in the tendon’s attachment to the medial foot. When this occurs, it is referred to as enthesopathy rather than tendonitis. Plantar Fasciitis is often most painful on its attachment to the inner heel bone, although there can be a pain in the mid portion around the foot’s medial arch.

Both conditions are painful first thing in the morning, made worse with activity and improve when rested. A clinical examination can achieve a differential diagnosis alongside an ultrasound scan.

Related Article: How to cure Plantar Fasciitis in one week

Posterior Tibial Tendonitis vs Achilles Tendonitis

Posterior Tibial Tendonitis is a condition of the Posterior tibial tendon where the pain is commonly located on the inner ankle and medial arch of the foot. Achilles Tendonitis is a condition affecting the mid-portion of the Achilles Tendon, which is located on the back of the ankle, attaching the calf muscle complex to the heel bone.

Related Article: Symptoms and Treatment for Achilles Tendonitis

Posterior Tibial Tendonitis vs Sprained Ankle

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 overstretches 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 overstretched, causing pain, inflammation and eventually tendonitis.

Secondly, a mild ankle sprain can lead to an 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 no mechanism of injury, it is unlikely to be a sprained ankle and a higher likelihood 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.

Related Article: Best exercises for Posterior Tibial Tendonitis

Posterior Tibial Tendonitis vs Stress Fracture

Posterior Tibial Tendonitis and stress fractures to the medial malleolus or the navicular bone can confuse.

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 key differences are that Posterior Tibial Tendonitis is usually worse first thing in the morning, worse after activity but improves with rest. In contrast, a stress fracture is consistently painful with use.

Related Article: Causes of Medial Malleolus Pain

Posterior Tibial Tendonitis vs Tarsal Tunnel Syndrome

The Tarsal tunnel is a minor groove on the inner ankle that contains blood vessels, nerves and some fatty tissue and this can become irritated through trauma or a biomechanical overload. In that case, 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. Along the medial arch of the foot during or after us, but unlike Tarsal Tunnel Syndrome, it does not provide any neurological symptoms.

Related Article: Tarsal Tunnel Syndrome: Symptoms & Treatment

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