'Ankle Pain when walking – Tendinopathy Treatment’
Tibialis Posterior Tendinopathy is very often responsible for Ankle pain that is located on the inside of the ankle joint. The Tibialis Posterior tendons role is to help control the midfoot when walking and running. Poor walking or running technique or sudden excessive exercise leads to overload and injury of the tendon. The best treatment technique for this condition is painfree progressive exercise Loading of the Tendon.
Pain is felt along the Yellow Line
Signs & Symptoms
Pain & Discomfort on the inside of the Foot behind the ankle joint known as the medial malleolus bone. There can also be pain on the medial arch where the tendon attaches to the Navicular bone.
Inability to complete a single Leg Heel Raise due to pain and weakness.
When tested in clinic there is pain when turning the ankle inwards against resistance
There can be swelling on the inside ankle joint behind the medial malleolis possibly indicating tenosynovitis which is inflammation of the tendon.
Patient experiences pain when pushing off the forefoot (toe region) during walking
Treatment & Management
Stop all aggravating activities such a long walks or running & replace them with swimming or cycling to maintain your cardiofitness.
When walking, you should land more on your midfoot in a soft contact rather than a heavy heel strike. This helps to keep the tibia or shin bone more vertical and hence reduced tibialis posterior tendon load. Also, focus on shortening your stride when walking. When using stairs focus on keeping your knee over your foot in order to improve Hip & Knee alignment.
Taping techniques to help reduce tendon load need to be applied to the Ankle for a 2-4 week period, the patient will be educated on how to apply such techniques. Alternatively orthotics can be used, but taping is the cheaper option.
Rehabilitation of the Tibialis Posterior tendon can take up to 3 months. Exercises are performed with the ankle taped, initially with painfree isometric sitting exercises with the ankle turning inwards progressing to rubber theraband exercises. Further painfree progression involves double leg heel raises with an outward pulling band to help isolate load in the Tibialis Posterior Tendon. These exercises are complicated and require instructional guidance from your Physical therapist.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672