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Tibialis Posterior Tendinopathy in Football Players

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Introduction

Welcome to “The Football Physio”! In this blog, we will explore the management of tibialis posterior tendinopathy in football players. Tibialis posterior tendinopathy is a condition that affects the tibialis posterior tendon, leading to pain and dysfunction in the foot and ankle. Throughout this article, we will cover its underlying causes, assessment methods, and treatment options for football players.

Understanding Tibialis Posterior Tendinopathy

Tibialis posterior tendinopathy refers to the degeneration or inflammation of the tibialis posterior tendon, which runs along the inner side of the ankle and foot. This tendon plays a vital role in stabilising the arch of the foot and controlling foot movement during walking, running, and jumping.

Symptoms of Tibialis Posterior Tendinopathy

Footballers with tibialis posterior tendinopathy may experience the following symptoms:

  • Pain and swelling: Footballers may feel pain and swelling along the inner side of the ankle or foot, specifically near the tibialis posterior tendon. The pain can range from mild to severe and may worsen during activities that involve running, jumping, or kicking.
  • Tenderness and warmth: The affected area may be tender to touch, and there may be localised warmth or redness around the tendon. This can indicate inflammation or irritation of the tendon.
  • Difficulty with foot and ankle movements: Footballers may experience limitations in certain foot and ankle movements. They may have difficulty pointing their toes downward (plantarflexion) or inward (inversion), as these motions can aggravate the tendon and cause pain.
  • Arch collapse or flattening: Tibialis posterior tendinopathy can contribute to a condition known as adult-acquired flatfoot, where the arch of the foot collapses or flattens. This may cause the foot to appear wider, and footballers may experience pain and instability when walking or participating in sports.
  • Gradual onset and progression: Symptoms of tibialis posterior tendinopathy often develop gradually over time. Initially, footballers may only experience mild discomfort or stiffness that worsens with activity. Without proper management, the symptoms can progress and impact performance on the field.
  • Swelling and thickening of the tendon: In some cases, the tibialis posterior tendon may appear swollen or thickened. This can be observed and assessed by a healthcare professional through physical examination or imaging studies.

If footballers experience persistent or worsening symptoms suggestive of tibialis posterior tendinopathy, it is important to consult with a healthcare professional or a sports medicine specialist. Proper diagnosis, treatment, and rehabilitation are essential to manage the condition effectively and prevent further complications.

Causes of Tibialis Posterior Tendinopathy

Tibialis posterior tendinopathy can be caused by various factors, including:

  • Overuse and repetitive strain: Activities that involve excessive stress on the tibialis posterior tendon, such as running, jumping, and sudden changes in direction, can contribute to its degeneration.
  • Foot and ankle biomechanics: Abnormal foot pronation (flat feet), high arches, or imbalances in foot and leg alignment can increase the risk of tendon overloading and subsequent injury.
  • Trauma or acute injury: Direct trauma or sudden ankle sprains can result in tibialis posterior tendon damage.
  • Age-related degeneration: The tendon’s structure may degenerate over time due to natural aging processes.

Assessment of Tibialis Posterior Tendinopathy

Accurate assessment is crucial for diagnosing and managing tibialis posterior tendinopathy. The assessment process may involve the following:

  • Medical history: Gathering information about symptoms, previous injuries, and activities that aggravate the pain.
  • Physical examination: Assessing foot and ankle alignment, range of motion, muscle strength, and performing specific tests to elicit pain or tenderness along the tibialis posterior tendon.
  • Imaging studies: Ultrasound, or MRI scans may be used to visualize the condition of the tendon and assess the extent of damage or degeneration.

Treatment Options for Tibialis Posterior Tendinopathy

The management of tibialis posterior tendinopathy involves a comprehensive approach to relieve pain, promote healing, and restore function. Treatment options include:

  • Rest and activity modification: Avoiding activities that exacerbate symptoms and allowing the tendon to rest and heal.
  • Orthotic devices: Custom orthotic inserts or footwear modifications can provide support, correct biomechanical imbalances, and reduce stress on the tibialis posterior tendon.
  • Rehabilitation: Targeted exercises to strengthen the foot and ankle muscles, improve flexibility, and restore proper movement patterns are essential for rehabilitation.
  • Immobilisation: In severe cases, immobilisation with a walking boot or cast may be necessary to allow the tendon to heal.
  • Extracorporeal shockwave therapy: This non-invasive treatment involves the application of high-energy sound waves to stimulate healing and reduce pain.
  • Surgical intervention: In rare cases where conservative measures fail, surgery may be considered to repair or debride the damaged tendon.

Products that may help

Voltarol Gel – View this product on Amazon for more details

This can be applied to the irritated part of the Tibialis Posterior tendon to help reduce pain and inflammation.

Insoles – View this product on Amazon for more details

Insoles can provide extra foot padding and shock absorption which can provide some protection for the pain and discomfort from Tibialis Posterior Tendinopathy.

Foam roller with mini bands – View this product on Amazon for more details

The foam roller can be used for self massage on the calfs and other lower limb muscle groups. The mini bands are useful for strengthening or muscle activation work.

Ankle Ice Pack – View this product on Amazon for more details

This foot & ankle ice pack provides cold therapy for the entire foot and ankle area, providing pain relief and helping to reduce swelling. The ice pack contains gel to ensure longer lasting cold therapy and the ankle specific design also provides compression to the injured area.

Rehabilitation Techniques

Rehabilitation plays a critical role in the recovery process for tibialis posterior tendinopathy. The following rehab techniques can be implemented:

  • Cardiovascular conditioning: Maintaining cardiovascular fitness through low-impact activities such as swimming or cycling can help maintain overall fitness during the recovery period.
  • Balance and proprioception training: Exercises that challenge balance and improve proprioception (awareness of body position) can enhance functional recovery and reduce the risk of future injury.
  • Strengthening exercises: Targeted exercises for the foot and ankle muscles, including the tibialis posterior, can enhance stability and support.
  • Eccentric exercises: Eccentric loading exercises focus on controlled lengthening of the tibialis posterior tendon to stimulate tissue remodelling and improve tendon strength.
  • Gait retraining: Analysing and modifying running or walking patterns to reduce stress on the tibialis posterior tendon and encourage proper foot mechanics.
  • Gradual return to activity: A phased rehabilitation program that gradually reintroduces football-specific activities and gradually increases intensity, speed, and direction changes.

Conclusion

Tibialis posterior tendinopathy can be a challenging condition for football players, but with proper management, it is possible to overcome its limitations and return to the game. Early diagnosis, conservative treatment approaches, targeted rehabilitation techniques, and a gradual return-to-play program are key components in successful management. Remember to consult with a qualified healthcare professional for an accurate diagnosis and personalised treatment plan. By following the appropriate strategies and dedicating time to rehabilitation, football players can regain strength, function, and enjoyment of the sport.

Further Reading

Ross et al, (2018) – Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines

Beeson, (2014) – Posterior tibial tendinopathy: what are the risk factors?

Yao et al, (2015) – Posterior tibialis tendon dysfunction: overview of evaluation and management

Disclaimer

The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.

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