■ ■ ■ Description

Posterior tibial tendon rupture is a complete tear of the posterior tibial tendon. This structure is the tendon attachment of leg muscles (posterior tibialis) to the inner part of the foot. There is loss of continuity between the inner leg muscles and the foot and thus loss of function of the muscles. The function of the posterior tibialis muscle is to forcefully push the front of the foot down (such as when standing on toes and pushing off with walking, running, or jumping) and turn the foot inward.

​

​

​

​

■ ■ ■ Common Signs and Symptoms

• A pop or rip felt behind the inner part of the ankle

• Pain and weakness with moving the foot (especially when pushing down with the front of the foot or turning it inward)

• Inability to or weakness with attempts to stand on the toes or ball of foot

• Tenderness, swelling, warmth, and redness around the posterior tibial tendon

• Bruising at the heel after 48 hours

• Flat foot (only on the injured side)

​

​

​

■ ■ ■ Causes

• Sudden episode of stressful overactivity, such as with jumping, hurdling, or starting a sprint

​

​

​

​

■ ■ ■ Risk Increases With

• Sports that require sudden, explosive muscle contraction, such as those involving jumping and quick starts; also with running or contact sports

• Poor physical conditioning (strength and flexibility)

• Previous or untreated posterior tibial tendon injury

• Cortisone injection into the posterior tibial tendon

• Obesity and decreased circulation due to cardiovascular problems

​

​

​

​

■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning:

  • Ankle and leg flexibility

  • Muscle strength and endurance

  • Cardiovascular fitness

  • Ideal body weight

• Arch supports (orthotics), taping, protective strapping, or an adhesive bandage may be recommended before practice or competition.

​

​

​

​

■ ■ ■ Expected Outcome

Surgery is recommended to allow the greatest likelihood of return to full activity with least risk of complications. Sports usually can be resumed after 4 to 9 months.

​

​

​

​

■ ■ ■ Possible Complications

• Weakness of the posterior tibial muscles, especially if untreated, resulting in problems standing on toes and pushing off

• Rerupture of the tendon after treatment

• Prolonged disability

• Flat feet

• Arthritis of the foot.

• Risks of surgery, including infection, injury to nerves (numbness, weakness), bleeding, and pain

​

​

​

■ ■ ■ General Treatment Considerations

Initial treatment consists of not walking on the affected leg, icing the area, applying a compressive elastic bandage, and elevating the injured leg to eye level. Definitive treatment options include surgical and nonsurgical intervention.

• Nonsurgical treatment is usually reserved for patients with medical problems or after chronic injury.

• Surgical treatment usually involves sewing the ends of the tendon back together, followed by immobilization in a cast (usually a short leg cast, below the knee to toes). If the injury is not acute, reconstruction by using another tendon to replace the function of the torn posterior tibial tendon is often recommended if there is no arthritic change already in the foot. This is because the tendon often cannot be repaired in chronic (old) injuries. If arthritis exists, fusion of the affected joints usually is recommended.

​​

​

​

​

■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician. Use only as directed and only as much as you need.

​

​

​

​

■ ■ ■ Notify Our Office If

• Pain increases despite treatment

• Cast discomfort develops

• Any of the following occur after surgery:

  • You experience pain, numbness, or coldness in the foot and ankle

  • Blue, gray, or dusky color appears in the toenails

  • You develop signs of infection, including fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)