Posterior Tibialis Tendinopathy

I thought we would dive into a lesser-known condition, posterior tibialis tendinopathies. This is again a common injury in runners and one that I see in the clinic frequently. 

The posterior tibialis is a muscle found on the backside of your tibia (shin bone). It runs from here, down the INSIDE of the ankle, and attaches to the navicular (bone inside of your foot). One of the jobs of this muscle is to control pronation of the foot. 

Pain in this condition is commonly felt on the INSIDE of the ankle, following the pathway of the tendon. Like other tendinopathies, this pain may be present initially, then “warm up” as you’re getting into the thick of things. It may then be painful to run or walk by the end of the run or afterward. 

Posterior tibialis tendinopathies are overuse/repetitive injuries. Similar to IT Band Syndrome, the muscle/tendon may not have the strength/endurance to withstand the forces of running. We commonly see this in runners that increase their mileage too quickly without adequate recovery. 

So what do you do? As with many running injury’s, the earlier the intervention the better. Load management and strengthening are key. A common compensation that I see with this is when a patient does a calf raise, they tend to bias the motion towards the outside of their feet. With many tendinopathies, loading/strengthening the tendon in appropriate ways is very important. Just resting may not fix this issue. 

Here are a few exercises that helps target the regions we’ve discussed!

1️⃣Hip Airplanes 

2️⃣Step Up w/band

3️⃣Posterior Tibialis Calf Raises

Check out @dr.jeffwong on Instagram for videos of these exercises!