What is Posterior Tibial Tendonitis
When You Roll Your Ankle and the Pain is on the Outside of the Foot, You Have Most Likely Strained the Peroneal Tendons
Tendinitis of the Foot
Tendinitis can affect four different tendons of the foot - the achilles tendon, posterior tibial tendon, the anterior tibial tendon and the peroneal tendon.
If a person has tendonitis of the foot, he or she may have inflammation at the in-step area of the foot and also have a flat foot deformity. The inflammation can be caused by irritation and tiny tears in the posterior tibial tendon over time (referred to as chronic tendonitis) or due to an immediate traumatic strain or tear (referred to as acute tendonitis).
Symptoms of Foot Tendonitis
You might be suffering from a Posterior Tibial Tendon Injury if you have:
- Pain on the inside of your foot (medial) centered around the in-step area. Pain can be shooting, stabbing or buring in nature.
- Inflammation on the inside of your foot (medial) centered around the in-step area.
- Decreased Arch Height, as this tendon assists in holding the arch of the foot upward.
- Weakness when rotating your foot inward (inversion) as this tendon prevents your foot from rolling.
- Foot Instability.
- Increased Arch Height.
- When standing on their toes, the patient will feel intense pain in the arch of their foot.
A Posterior Tibial tendon injury is usually caused by repetitive use of the tendons, but can also be caused by trauma such as a rolled or sprained ankle. Little tears in the tendon irritate the tendon fibers resulting in pain and inflammation, resulting in an inability to maintain strength along the tendon.
Posterior Tibial tenosynovitis is swelling and inflammation of the tendons' sheath (or covering) which prevents the tendons from gliding smoothly within the sheaths, causing pain. It can be experienced at the same time of posterior tibial tendonitis, and has similar symptoms. It often results in trouble moving the ankle and will feel sore to the touch. In rare cases, tenosynovitis can be caused by infection, so it is always recommended to check with your doctor to rule this out as a cause.
Tearing of the tendon is not uncommon. This leads to pain, swelling, sensitivity and a sense of instability in the ankle. The tendon(s) can also pop out of the supporting ligaments that hold them in place; this is known as a tendon dislocation.
Who is Most at Risk of Foot Tendonitis?
- People who play sports or do activates that involve repetitive ankle movements.
- People who participate in activities such as running on uneven surfaces, racket sports, basketball, hiking, or skiing.
- People who wear ill-fitting shoes or shoes that cause foot instability, as these shoes will increase the risk of an inward rolled ankle
- People in aging populations, because our tendons lose elasticity and become brittle.
What Causes Posterior Tibial Tendonitis
Peroneal tendonitis is the degeneration of the tendon tissue in the ankle. What causes our tendon to start to fall apart?
- Poor footwear encouraging your foot to roll inward stretching the tendons.
- Improper training to an exercise program you have just started
- Repetitive ankle motions in sports, such as running and jumping
- A blow to the inside of the ankle or an ankle sprain
- A flat foot puts extra tension on the posterior tibial tendons. Chronic flat foot syndrome may mean your posterior tibial tendons have lengthened permanently.
- Incorrect alignment of heel and foot bones
- A build up of scar tissue on the tendon, the weakened area of the tendon may tear or lead to rupture
Posterior Tibial Tendon Dislocation (subluxation) / Tearing or dislocation can happen in 1 or both of these tendons. This leads to pain, swelling, sensitivity and a sense of instability behind the outside of the ankle. They can also pop out of the supporting ligaments that hold them in place (a dislocation). After this happens you might repeatedly dislocate the tendons in your ankle and this tissue will tear even more without proper treatment. If you suffer from torn (ruptured) or dislocated peroneal tendons you might need stitches or even a tendon replacement to fix the problem.
How Do I Diagnose Posterior Tibial Tendonitis
The diagnosis of posterior tibial tendonitis is usually made by examination of the ankle. A physical check by your doctor will help to determine where the tendons are inflamed, ruptured, or degenerated. The doctor will move your ankle into different positions during a physical examination. These tendons are usually checked by using the single foot raise.
Single Foot Raise
The patient is asked to stand with full weight on the afflicted foot with the other foot in the air. At this point the patient is asked to raise up on their toes. If the tendon is attenuated or ruptured, the patient will be unable to do so. In cases of tendonitis or tendinosis, the patient may be able to do so but it will be painful.
X-rays may be ordered to make sure there is no fracture or other problem with your fibula or the other bones in your ankle. Your doctor may order a magnetic resonance imaging (MRI) scan of your ankle. These images can show if there is abnormal swelling or scar tissue in the tendons. MRI scans can also show lengthwise tears in the tendons.
Peroneal Tendon Injury Scar Tissue Growth
Overuse or injury (direct trauma, a fall, an accident or rolling over on your ankle) will cause weakness and loss of range of motion in the ankle, and the tendons become irritated and inflamed. A posterior tibial tendon strain is kind of like taffy that has been overstretched until it becomes thin and eventually frays.
The tendon tries to protect itself from this constant irritation by trying to repair the damaged tissue. During the healing process your body will automatically fill in tears in your tendons with dense, brittle tissue called "scar tissue". The human body will use scar tissue as a temporary healing solution and will try to build the scar tissue as fast as possible to heal tears in your peroneal tendons. Scar tissue can form fast to strengthen the damaged tendon, but working fast doesn't mean that the job's done right. When scar tissue forms it doesn't come together as neatly as regular (healthy) tendon tissue would. Scar tissue fibers will lay down over top of your tear in a cluttered, messy and jumbled up way.
This is how scar tissue works. The scar tissue that forms in and around your strained ankle tendons will be unorganized and won't line up properly with the healthy tissue surrounding the tear. This scar tissue will also attach to everything in and around your ankle including the surrounding healthy tissue as well. This can result in a long-term fusing together of your tendon with everything around it; this will definitely freeze up your ankle, severely reducing your mobility.
Scar tissue is a weak form of collagen - hard, inflexible, and tough to get rid of once it begins to take hold. The more scar tissue that develops, the more you lose range of motion. With excess scar tissue build up, the injured soft tissue and the ankle in general will remain weak and prone to re-straining and re-tearing.
While you can go a number of days and even a few weeks without any major setbacks during the injury.. inevitably, a certain movement or motion will happen that causes your injured soft tissue to strain and even tear once again. This is attributed to the scar tissue build up and will result in the buildup of yet more scar tissue and a further reduced range of motion (ROM).
The more scar tissue that develops, the greater the risk of winding up permanently injured with chronic pain or arthritis. Scar tissue means that your joint will not perform as well as it once did and it makes it much more prone to injury later on. The longer the injury remains, the risk of atrophy increases and the risk of more scar tissue increases. This is why it is critical to treat your tendon injury now rather than later.
Continuous re-injury and build-up of scar tissue makes it more likely that you will wind up with chronic pain, reduced Range of Motion or even arthritis (permanent damage).
Nonsurgical Treatment for Posterior Tibial Tendonitis
If you have a lot of pain you may need to have a walking boot or cast for 2 to 4 weeks. If there is no pain or tenderness with walking a stirrup ankle brace, arch support, or lateral heel wedge can help to take tension off of your injured tendons.
In most cases, your Doctor will start with nonsurgical treatments options. Some of the options your doctor may recommend include drugs or medications like NSAIDs (non-steroidal anti-inflammatory drugs) to manage pain and inflammation. Your physician may also recommend specific footwear or refer you to a podiatrist. Alternative medications like cortisone injections are NOT advised for any type of tendon condition. This is because there is increased risk of rupture of the tendon following a cortisone injection.
Be Careful About Cortisone
Steroid injections can provide temporary relief from the pain of tendon related injuries and are very popular. However, these injections should generally be avoided if possible as they weaken the tendon and may lead to a rupture. If you do opt for an injection, doctors usually recommend that you do not participate in strenuous activities for several weeks to reduce the risk of a rupture.
"In other words, in some way, the cortisone shots impede full recovery, and compared with those adopting a wait-and-see policy, those getting the shots 'are worse off'. Those people receiving multiple injections may be at particularly high risk for continuing damage. (reference: Reynolds, G. (1288). Phys Ed: Do Cortisone Shots Actually Make Things Worse?. Well. Retrieved 17 November 2016, from website)
Doctors won't give you a cortisone shot if it's at all possible that you have a fracture (acute or chronic) in your sesamoid bone(s). If cortisone is used with even the slightest stress fracturing, the cortisone will make the injury worse by stopping the bone's natural healing process. Over time if left untreated, your fracture will get worse and surgery will be more likely needed.
"Complications of cortisone shots can include:
"Risks - Cortisone Shots - Mayo Clinic". 2016. Mayoclinic.Org. Accessed November 17 2016. website
- Joint Infection
- Nerve Damage
- Thinning of skin & soft tissue around injection site
- Temporary Flare of Pain & Inflammation in the Joint
- Tendon Weakening or Rupture
- Thinning of Nearby Bone
- Death of Nearby Bone
- Temporary Increase in Blood Sugar"
Treating Posterior Tibial Tendonitis - What You Can Do!
The good news is that most posterior tibial tendinitis injuries will heal with conservative treatments and surgery is often not needed! But what's better for posterior tibial tendonitis - heat or cold?
Foot Tendonitis Home Conservative Treatment Options!
Step 1 - Reduce Pain and Swelling with Cold Compression
The first step for conservative treatment of your foot tendonitis is to reduce the swelling to "open up" the area for more blood flow. Anyone in the health-care business knows that your blood supplies the oxygen and much needed nutrients required to heal foot tendonitis injuries. This is why for years, doctors, trainers, and other medical professionals have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.
This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood to your damaged tendon and tissue cells begin to break-down. Without cold compression therapy cellular break-down and tissue damage continues because the cells can't get the oxygen they need to survive. By limiting the amount of damage done to your tendons, you also limit the amount of healing that needs to occur. This is a very important step to heal acute or chronic tendon injuries faster and with less pain!
Use a Cold Compress or Ice Pack:
- 24 to 72 hours after your initial tendon injury or when you first notice pain and swelling in your foot to stop cellular damage, relieve pain, and decrease swelling.
- After exercise, workouts or activity of any kind to prevent re-injury of your foot tendonitis.
- Before and after surgery during rehabilitation to control pre and post-surgery pain and swelling.
- Anytime you feel your foot has been over-extended, over-worked, twisted, strained or sprained causing pain and swelling.
- Anytime you have swelling, sharp throbbing pain or inflammation in the tendons in your foot.
- Any other situation where you need to draw the pain and inflammation out of your foot.
Step 2 - Improve Circulation, Soften Scar Tissue & Prevent Re-Injury with a T•Shellz Wrap®
T•Shellz Wraps® contain a unique Carbon Fiber Energy Pad which is flexible and will shape to conform to your body. This Energy Pad emits a uniform wave of perfectly safe electromagnetic energy over its entire surface. This energy travels deep inside to the soft tissue in your body, stimulating blood flow your own body needs to heal your injury. It is the electromagnetic energy that is crucial to the healing process.
Deep Heat Increases Blood Circulation
Greater Blood Circulation Results in
Faster Healing of Soft Tissue
T•Shellz Wrap® = Deep Heat
Best of all...
The T•Shellz Wrap® is an FDA Registered Medical Device and is suitable for use in therapeutic clinics and FROM HOME. It is completely safe for people and patients to use for themselves.
As mentioned earlier, the use of electromagnetic energy is becoming much more commonplace in North America for everyday people. The technology has been used for decades in the worlds of professional and amateur - a contributing factor as to why athletes seem to recover from injuries so quickly.
Have you ever wondered by an athlete can return to activity after 3 or 4 weeks following a tendon injury - while your average person takes much longer to return back to normal? The secret isn't really that much of a secret - it involves consistent treatments (meaning multiple times a day) using a diathermy treatment like the T•Shellz Wrap® to stimulate blood flow to injured soft tissue. Most athletes have the luxury of using in-house therapy facilities many times per day.
How many us can afford the time and money to visit a therapy clinic multiple times a day? Very few indeed. This is how you can gain the same advantage that athletes enjoy in healing their own injuries - by using a device like the Shoulder T•Shellz Wrap® two or three times a day on a consistent basis.
Consistent Treatments = Consistent And Long Term Improvement
Click HERE to Go To Our Online Store If you have questions, call our office at 1-866-237-9608 (toll free continental US).
What Else Makes the T•Shellz Wrap® So Special?
We believe the T•Shellz Wrap® to be one of the most effective treatments to stimulate blood flow to dense, injured tissues such as muscles, tendons, ligaments, and other similar tissues.
We can promise that you will receive a product that is designed to be safe and does what it is supposed to do...quickly relieve pain and aid in the recovery from tendon, muscle and other soft tissue injuries.
The unit plugs into a standard wall outlet to get its power. The nice thing about the power supply is that the same unit can be used in North America and overseas as well. It has the capability to operate between 110v and 230v.
It has a special signal controller that can be set for 3 different power levels of application (3=High, 2=Medium, 1=Low). The cord is long so you can sit or lie comfortably and watch TV, read or surf the net while you're using it.
Treatments are max 30 minutes in duration and the device can be worn over clothing. This allows you to use the device at work, at home, or really anywhere you have access to an electrical outlet.
A Recap of the Benefits of the T•Shellz Wrap®..
- Wraps are available for all major joints - very versatile!
- Targeted treatment of Tendinosis, Tenosynovitis, Tendon Tears, Bursitis, Impingement, Arthritis, etc
- It can be used before exercise to warm up your tendons and muscles to reduce the risk of injury
- FDA Registered medical device for use in home or clinics - very high quality
- Increases temporary flexibility and length of tissues (reducing the re-injury factor)
- Carbon fiber Energy Pad is strong, lightweight, and flexible - contours very easily
- It soothes pain and whisks away toxins
- It provides deep heat, which the body responds to by increasing blood flow. Increased blood flow enhances the healing rate - saving time and money when associated with extended doctor or physical therapist visits
- it is an outstanding tool for post-surgery rehabilitation, getting you back to work faster
When Should I Use My T•Shellz Wrap® During the Day?
The most common question we receive from individuals prior to purchasing is - how many times a day should I be using my wrap and when should I be using them? While treatment plans will differ for each individual and their specific injury, there are general guidelines that should be adhered to.
- Use a Cold Compress or Ice Pack when you are experiencing inflammation (usually after exertion or movement of the injury area).
The T•Shellz Wrap® would then be used:
- Right after rising from bed in the morning (as this is when it is most stiff)
- Prior to going to bed at night (to relax the area and allow for better sleep)
- Before you know you will be using your injured joint (going to work, driving, typing, etc).
Step 3 - Stretch Your Foot to Speed Up Recovery
The final step in foot tendonitis recovery is stretching - this is a critical step for complete recovery from your injury!
Physical therapists almost always prescribe gentle stretching for to deal with foot tendonitis, and if no device is available, they usually prescribe something called "heel slides". In a physical therapy office, your therapist will help you to perform a heel slide if your foot hurts too much to do it on your own.
Outside of the physical therapy office (when trying this stretch at home), your therapist might suggest that you try to use a plastic bag, cookie sheet, tension band, belt or any other household tool to help you move your foot.
You'll find in most rehabilitation programs heel slide stretching and conservative treatment will help to:
- build muscle strength in your lower leg (calf muscle)
- increase mobility and range of motion (ROM)
- speed overall healing of your foot tendonitis
- prevent muscle loss (atrophy) in your lower leg
- improve muscular function and capability
- refine tendon tissue alignment and physical balance
- encourage overall foot and ankle joint flexibility
- facilitate proper warm up for regular exercise
- promote healthy circulation in your foot
Use These Conservative Treatment Tools
to Deal with Scar Tissue
It's important to rest the torn tendon because our natural healing process takes time to heal completely. If you don't rest your torn tendon, your acute tendonitis can quickly turn into a chronic tendonitis injury. To repair our damaged tendon tissue quickly, our bodies will use scar tissue to fill in the tears in the tendon. If you need to rest for an extended period of time and avoid certain activities that make your pain worse, you'll be more likely to develop massive amounts of this scar tissue as a temporary healing measure.
Scar tissue may plague you for weeks, months and maybe even years, depending on your level of activity and the amount of conservative treatments you have done during your rehabilitation. Scar tissue is a major problem, especially when it comes to re-injury of your tendon. When dealing with scar tissue it's always important to:
- listen well to your physician and if conservative treatments are recommended, remember to stick to your (daily) treatment plan using these therapies.
- frequent use of a Cold Compress or Ice Pack will help reduce the swelling quickly. Much of the pain you feel will be from the swelling, and you'd be surprised how fast the pain drops off once the swelling is down.
- The T•Shellz Wrap® is a safe, electromagnetic energy device that will help reduce scar tissue and increase blood flow to the area - thereby accelerating the body's own healing process.
- when applied before stretching, deep heat provided via the T•Shellz Wrap® will help the connective tissue in your joint elongate, and stay elongated for some time after treatment. It will also temporarily increase the flexibility of soft tissue, meaning that it helps improve range of motion while simultaneously reducing your risk of re-injury which is exactly what you want when trying to recover from soft tissue injuries.
- stretching, as assigned by your Physical Therapist can not only get rid of scar tissue, but also promote growth of healthy, flexible tissue.
Preventive measures for all types of foot tendinitis include, proper warm up and stretching exercises, wearing the right shoe for the activity, choosing shoes with good arch and heel support and varying your exercise route and routine. (This will help keep one set of muscles from being overstressed).
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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!