Best Practice Case Studies-Case 112 Asset 7 Peroneal Tendon Injury

Pdf Summary

Posterior tibial tendinopathy is an injury of the posterior tibial tendon, which helps stabilize the ankle and supports foot movements that point the foot inward and downward. The condition includes both tendonitis (inflammation) and tendinosis (degeneration over time). It most often develops gradually from overuse and over-pronation, especially in runners, though it can also occur suddenly from overload, such as in dancers. People with flat feet (pes planus) are at higher risk.<br /><br />Symptoms typically come on slowly and are usually felt as pain behind the inner ankle bone, worsened by walking or lifting the foot. Pain may also radiate up the back-inner calf. If untreated, the arch may continue to flatten and symptoms can progressively worsen.<br /><br />Diagnosis is mainly based on a sports medicine evaluation and physical exam, which may show tenderness along the inside ankle and foot and difficulty performing tip-toe walking or a single-leg heel rise. Imaging is not always necessary, but X-rays or MRI may be used to rule out other problems such as stress fractures or flexor hallucis longus (FHL) tendon injuries.<br /><br />Initial treatment commonly starts with RICE (rest, ice, compression, elevation). Anti-inflammatory medications like ibuprofen or naproxen can help with pain, but physical therapy is the main treatment to restore strength, balance, and flexibility. In more severe cases, short-term immobilization in a walking boot or short leg cast for 2–3 weeks may be recommended. Surgery is rarely required.<br /><br />Prevention focuses on gradually increasing activity levels and, for those with flat feet, considering arch-supporting orthotics. Return to play is appropriate only after rehabilitation and when sport-specific movements can be performed without symptoms, as returning too early can cause reinjury or even tendon rupture. Orthotics and ankle taping may provide added support during activity.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 112

Topic Ankle

Keywords

posterior tibial tendinopathy

posterior tibial tendon dysfunction

ankle medial pain

overpronation injury

flat feet pes planus

runner overuse injury

tendonitis vs tendinosis

single-leg heel rise test

RICE treatment

physical therapy and orthotics

4th Edition

Ankle

4th Edition, Case 112