What is Posterior Tibial Tendonitis


If You Roll Your Ankle and the Pain is on the Outside of the Foot, You Have Most Likely Strained the Peroneal Tendon. Click here to read more about Peroneal Tendinitis.


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 is suffering from posterior tibial tendon damage, 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).

Posterior tibial tendonitis/tendinitis.


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 can be caused either by repetitive use of the tendons, or 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 means you are suffering from swelling, microtearing and/or inflammation of the tendons' sheath (or covering) which prevents the tendons from gliding smoothly within their 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 posterior tibial tendon is not uncommon. Tearing 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
What Causes Peroneal Tendonitis

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 test.

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.

What is posterior tibial tendonitis

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 Conservative Treatment Options 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 non-surgical 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. Steroid injections are advised with caution for any type of tendon condition as there is increased risk of tendon rupture.
(reference: American Academy of Orthopaedic Surgeons)



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 tissues begin to break-down. Without cold compression, tissues break down further because they 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 tissue damage at the microscopic level, 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®

Once the swelling is gone, moving the tendon and applying a local circulatory stimulation device like the T•Shellz Wrap® is really what is needed for completing the recovery cycle. This is critical because tendons are known to receive very little natural blood flow and blood flow is really how your body is able to heal itself. When the tendon tissue is damaged, the already-reduced blood flow is decreased down to a trickle which is why movement is encouraged - it helps get blood flow to where it is needed.

Blood flow (healthy circulation) is an important part of natural tissue healing. Injured tendons take the nutrients available in local blood flow (like oxygen and healing agents) to get rid of any damaged tissue and start growing healthy tissue.

In some cases of acute tendonitis, the micro-tearing is located in an area known as the watershed zone.

The watershed zone is basically a part of the tendon that has the weakest amount of blood supply (even when it's completely healthy with no tears). This area usually gets blood supply from peripheral veins. This reduced blood supply makes the watershed zone an area of your tendon that's prone to injury and a poor healing response.

Many tendons in the body are known to have watershed zones that are prone to tendon tears. Some of the tendons that have a watershed zone include the Achilles tendon, the posterior tibial tendon in the foot / ankle, the rotator cuff (supraspinatus) tendon in your shoulder, the bicep and tricep tendons in your arm and the flexor tendons in your hand.


Increased Blood Circulation = Increased Healing Capability


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 energy over its entire surface. This energy is absorbed by soft tissue in the treatment area, opening blood vessels, resulting in an increase in blood flow. Increased blood circulation is what your body needs to accelerate the healing of soft tissue and this is why we recommend the T•Shellz Wrap®.

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.

The technology found in a T•Shellz Wrap® has been used for decades in the worlds of professional and amateur sports - 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 soft tissue 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 treatment like the T•Shellz Wrap® to stimulate blood flow to the injured tissues. Most athletes have the luxury of using in-house facilities many times per day.

How many us can afford the time and money to visit a clinic multiple times a day? Very few indeed. This is how you can gain some of the advantages that athletes enjoy in their injury recovery - by using a device like the T•Shellz Wrap® two or three times a day on a consistent basis.

Consistent Treatments = Consistent And Long Term Improvement



What Else Makes the T•Shellz Wrap® So Special?

We believe the T•Shellz Wrap® to be one of the most effective home treatments to increase localized blood flow to soft tissue in and around the treatment area.

We can promise that you will receive a product that is designed to be safe and does what it is supposed to do... reduce pain (as stated in "Therapeutic Heat and Cold", 4th edition. - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin) temporarily increase length & flexibility of soft tissue (as stated in "Therapeutic Heat and Cold", 4th edition. - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin) and aid your body in recovering from tendon, muscle and other soft tissue injuries via enhanced blood flow.

order Leg T•Shellz Wrap

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.

The T•Shellz Wrap® 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 enough that 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.

Wrap Recommendations:


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.

We recommend 5 to 10 minute treatments to start; the safety shutoff controller is set to max 30 minutes in duration. The device can be worn over clothing and allows you to use the device at work, at home, or really anywhere you have access to an electrical outlet.


...A Quick Recap of Benefits That Can Be Achieved Via the T•Shellz Wrap®..

  • We have T•Shellz Wraps® that can fit on the back, hip, leg, arm, shoulder, knee, foot, toes, wrist and ankle
  • It can be used before exercise to warm up the problematic joint to reduce the risk of injury (heat elongates soft tissue and makes it more flexible)
  • FDA Registered medical device for use in home or clinics - high quality, 1 year warranty, 60 day trial period (100% refund guaranteed)
  • Increases temporary flexibility and length of tissues (reducing the re-injury factor)
  • It soothes pain and whisks away toxins
  • Carbon fiber Energy Pad is strong, lightweight, and flexible - contours very easily
  • A boost in blood flow helps maximize the body's ability to recover from soft tissue damage. This can be beneficial in saving time and money when associated with doctor or physical therapist visits
  • A boost in blood flow will maximize the body's ability to recover quickly. This can be beneficial in post-surgery rehabilitation, getting you back to work faster. Do not use until at least 6 weeks after surgery, and only after approval from your doctor.

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!

PTs almost always prescribe gentle stretching for to deal with foot tendonitis, and they will typically prescribe a set of stretches for you to do at home. In a clinic, your PT will help you to perform these stretches and exercises if your foot hurts too much to do it on your own.

You'll find in most rehabilitation programs, stretching combined with conservative treatments at home 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 Conservative Treatment Tools
to Deal with Scar Tissue

It's important to rest a partially torn or strained 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 treatments.
  • use a Cold Compress or Ice Pack to help reduce 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.
  • incorporate the use of a T•Shellz Wrap® once swelling and/or inflammation is gone. This wrap has many beneficial effects, not the least of which is a secondary effect of increasing blood circulation in the area. Soft tissue healing requires blood flow so when blood circulation is boosted, you are also boosting your body's ability to heal damaged soft tissue more quickly.
  • when applied before stretching, 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.
  • stretch at home as often as is assigned by your PT.
scar tissue restricts tissue fibers

Conservative Treatment Tools Our Clients Have Used to Help
Limit Damage & Boost The Body's Soft Tissue Repair Process at Home:

  • A Cold Compress or Ice Pack to reduce inflammation wherever there is pain and/or swelling (as soon as possible).
  • A TShellz Wrap to increase blood-flow to the treatment area (Circulatory Boost).
  • MendMeShop Arnica Pain Cream for temporary relief of pain due to sore muscles and joints.
  • An Exercise & Stretching Plan to prevent muscle atrophy and shortened tendons in the leg. A proper plan will increase elasticity and strengthen the muscles and tendons in the problematic joint area as well as tissues in the surrounding joints.

Conservative treatment tools just like these have been used successfully by thousands of soft tissue injury sufferers - just like you.




T•Shellz Wrap® = Enhanced Blood Flow in the Treatment Area

 

We believe the use of T•Shellz Wraps® for boosting blood flow to soft tissue in the area of application is one of the most under-utilized home treatment options available on the market today. We have client after client that have tried many options out there and have been amazed at how effective and fast the TShellz Wrap treatment can relieve pain and increase blood flow in the treatment area.

With regular use of the TShellz Wrap:

  • Your pain will be reduced*.
  • Due to increased blood flow, soft tissue in the treatment area will be expected to recover at an accelerated rate with reduced potential for re-injury*.
  • Tissue in the treated area should experience a larger range of motion and increased extensibility of collagen tissue* due to the heat effect on soft tissue. This should translate into a reduced rate of re-injury occurrence as soft tissue is known to lengthen and become more flexible when exposed to warm temperature. (*Chapter 9 of "Therapeutic Heat and Cold", 4th edition. (amazon.com link - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin)

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The Key Points To Keep in Mind When Treating Your Injury

Make Sure That Complete Healing is Your #1 Goal

We all know that if the injury was healed, the pain would go away but what about the opposite situation? If the pain is gone, does that mean the injury is better? Unfortunately, this is not always true.

Too many people only focus on suppressing pain symptoms while providing less attention to the true healing aspects of the body. Experiencing less pain, while obviously a good short-term goal, does not equate to underlying healing. Scar tissue can remain for months after one gets to a point of being relatively pain-free. However, as long the weak and brittle scar tissue remains, you are susceptible to re-injury or re-aggravation. Certain motions or movements can cause the weaker tissue to easily tear - resulting in some reversal of the recovery up until that point.

This is why we recommend for people to continue with their doctor or therapist recommended exercises and to continue with mild treatments of the T•Shellz Wrap® for a period of time - to better ensure complete recovery.

Ongoing treatments to enhance circulation are intended to soothe, relax and promote healing of damaged soft tissue in the application area. T•Shellz treatment also results in the ability of soft tissue to extend further due to the effect of heat on soft tissue. The more extensible your tissues are, the less likely they are to strain or sprain.

Resting The Area of Your Injury Will Help, But Only Temporarily

People tell us all the time, "I was told that if I stay off my feet for a few weeks, my pain will disappear for good."

The truth is, tendonitis pain is usually a culmination of numerous factors, such as repetitive stress, poor posture, acute injuries, and overcompensation issues resulting from other muscle and soft tissue ailments.

It may take weeks or months for these pain triggers to surface. When they , however, merely resting will solve the underlying issues. You need to utilize actions and options that actually treat the source of the pain and help reverse the damage that has been done.

Resting has a role to play, but it is only one small factor in a recovery plan.



Restricted Movement Is Risky If It Goes On For Too Long

Resting too long, or using bracing to restrict movement for extended periods of time, can decrease mobility of your Achilles tendon and increase pain.

For acute (new or recent) Achilles tendon tears that have the ability to heal on their own - your doctor may even cast your foot in a toe pointed position (in something called a "hanging enquinus cast") or in a removable brace/splint. A removable splint can be very helpful to prepare you for PT sessions and mobility exercises.

Prolonged use of a cast, removable splint, or long-term rest (restricted movement) without proper exercise or stretching can make your Achilles tendon injury worse. If your Achilles tendon remains completely immobilized and at constant rest, the ends of the Achilles tendon (where it attaches to bone or other muscles) will begin to fill in with scar tissue as part of the healing process. You may also have on-going symptoms of pain, swelling and inflammation, and even poor blood flow circulation.

Lack of proper blood flow and growth of scar tissue will decrease the natural length of the tendon (atrophy) and tighten tissue, reducing the flexibility between your ankle and foot. Your ability to push off with your foot in certain activities such as running, jumping, or going up and down stairs all become compromised. You are also at an increased risk of re-rupture of the tendon, especially if the initial injury was large and required surgery in the first place.

Prevention

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!


 
 

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