Posterior Tibial Tendonopathy/Dysfunction
What is it: The posterior tibial tendon runs behind the medial malleolus. This tendon can be injured with partial or micro tears or less commonly a full thickness tear.
How does it present: Patients will usually complain of medial ankle pain. It may have occurred after an acute ankle injury such as a twist, or it may have occurred after the start of a new activity such as running on the beach or playing a sport on an uneven field.
Common exam findings: Exam finding for a tendonopathy may show tenderness over the region of the tendon behind the medial malleolus down to its insertion on the navicular. Swelling in that region may be seen and resisting inversion of the foot may cause more pain. There may be weakness or pain when patients are asked to stand on their toes. With a complete rupture of the tendon, ecchymosis is often also seen and patients will be unlikely to be able to stand on their toes with the affected foot or they will lose the normal varus formation of the heel with standing on their toes.
Tests and treatment: X-rays of the ankle may be needed to evaluated for associated bony injuries. Evaluation of the posterior tibial tendon is best done with musculoskeletal ultrasound or MRI if indicated.