This spring many runners are training for upcoming races around the GTA, surrounding areas and some even travelling to different cities to participate in running events from 5-10Km runs to marathons, half-marathons and obstacle races. A common issue in this group of runners has brought many new and veteran runners into the clinic recently: pain on the inside of the ankle and shin ‘Tibialis Posterior Tendonopathy’.
What is Tibialis Posterior Tendonopathy?
The tibialis posterior muscle is the muscle located in the back inside of your lower leg and calf that is connected to the foot by a tendon that loops down behind the medial malleolus (inner ankle bone) and inserts in the bottom of your foot. This muscle is responsible for helping point your foot, supporting and stabilizing the arch in the bottom of your foot, and pushing off during running. Tendonopathy occurs when there is microtrauma, inflammation, degeneration or lengthening of the tendon due to over use or improper use of the muscle.
What are the symptoms?
- Pain on the inside of the lower leg and ankle
- Swelling on the inside of the lower leg and ankle
- Pain during walking and running, especially during weight bearing and push off
- Tenderness/pain when firmly touching the muscle and tendon
- Pain during single leg heel raises
Why does it occur?
- Repetitive and prolonged activities putting strain on the Tibialis Posterior (Running)
- Changes in foot wear
- Changes in training schedule – Increasing training too quickly or without enough rest time
- Poor biomechanics in the foot – excessive pronation (Flat footed)
- Muscle imbalances in the lower extremity including hip, pelvis and core
- Improper rehabilitation following a previous lower extremity injury
What does treatment for Tibialis Posterior Tendonopathy involve?
Initially activity modification and rest is important. Soft tissue massage, taping, and modalities such as acupuncture or Shockwave can help settle down the inflammation and help with to reduce the pain. Stretching, balance, and strengthening exercises are then initiated. Gradual introduction of strengthening exercises that mechanically load the tendon are important for the tendon to heal and be able to withstand future stress. For example strengthening starts with isometric exercises, then light concentric and eccentric exercises, then harder concentric exercises and finally plyometric exercises.
Sometimes the following conditions can appear to be a Tibialis Posterior Tendonopathy but are different issues that require very different rehabilitation
- Compartment Syndrome
- Stress Fracture
- Referral from the lumbar spine
- Deep Vein Thrombosis
Visiting a Physiotherapist or Chiropractor at Rebalance Sports medicine will help determine the source of your pain in order to treat you and get you back to running. Your therapist will investigate what factors led to the excess strain being placed on the Tibialis Posterior in the first place. Your rehabilitation will address those specific factors and root cause of your injury to avoid re-injury in the future so you’ll be ready to get back to running and training for your next race!
Written By: Bonnie Winship – Physiotherapist