Posterior Tibial Muscle Dysfunction: Symptoms, Causes, and Treatment Options

Soleus muscle dysfunction

Since I can remember, I have often stood for long periods and felt discomfort in the soles of my feet after walking for a while.
My classmates mentioned that I have an inward foot posture, but my family did not pay much attention to it.
I have been overweight throughout my life.
When I was younger, I sprained my right foot twice and saw a doctor, who only said that there were no fractures and that it would heal on its own.
However, I later noticed that my right ankle is slightly more swollen than my left ankle.
After entering college, I joined a sports club and managed to lose some weight, but I sprained my right foot again during a competition, which may have caused some underlying issues.
Now, I experience pain even while walking normally.
During this time, I have visited both small clinics and large hospitals, but they all diagnosed me with flatfoot and collapsed arches, recommending physical therapy.
However, the arch support insoles did not seem to help much, as my ankle still hurts even when the arch is supported.
I have been searching online and recently came across information about posterior tibial tendon dysfunction, which has symptoms and causes that closely resemble my condition.
However, I am unsure if I need surgery.

Could you please provide information on how hospitals treat patients with posterior tibial tendon dysfunction? I have seen doctors throughout my life, but none have provided a definitive diagnosis or advice.
The idea of posterior tibial tendon dysfunction feels like a glimmer of hope for my right ankle after all these years, but I do not know how to treat it.
How should I approach strength training to target the affected muscles? Here is the article I found on posterior tibial tendon dysfunction, which describes symptoms and causes that are very similar to mine: https://sites.google.com/view/bonenews/foot-and-ankle/flatfoot.

Miss Chen, 20~29 year old female. Ask Date: 2021/04/26

Dr. Chen Bochen reply Orthopedics

I sincerely suggest that you consult an ankle and foot specialist.
In the central region, Dr.
Chiu Chia-Hung has a good reputation in the industry, and I have referred several patients to him who have successfully received treatment.
However, I've heard that he is not very accommodating to difficult patients, so I hope you won't be one of them.
Additionally, I recommend that you stick with one physician for a period of time instead of constantly seeking treatment from different doctors.
Wishing you a speedy recovery.

Reply Date: 2021/04/26

More Info

Understanding posterior tibial muscle dysfunction is crucial for addressing the symptoms and challenges you are experiencing. The posterior tibial muscle plays a significant role in maintaining the arch of the foot and supporting the ankle. Dysfunction in this muscle can lead to various issues, including flatfoot, ankle instability, and chronic pain.

Symptoms
The symptoms of posterior tibial muscle dysfunction often include:
- Pain along the inside of the ankle and foot.

- Swelling around the ankle.

- Difficulty standing for long periods or walking long distances.

- Flatfoot or a noticeable collapse of the arch.

- Pain that worsens with activity and improves with rest.

Given your history of ankle injuries and the discomfort you experience while standing or walking, it is plausible that your symptoms are related to posterior tibial muscle dysfunction, especially considering the flatfoot diagnosis you've received.

Causes
The causes of posterior tibial muscle dysfunction can be multifactorial:
1. Injury: Previous ankle sprains or injuries can lead to muscle weakness or dysfunction.

2. Overuse: Activities that put excessive strain on the foot and ankle can exacerbate the condition.

3. Structural Issues: Flatfoot or other structural abnormalities can place additional stress on the posterior tibial muscle.

4. Obesity: Increased body weight can contribute to the strain on the foot and ankle, worsening symptoms.

Diagnosis
Diagnosis typically involves a thorough clinical evaluation, including a physical examination and imaging studies such as X-rays or MRI to assess the integrity of the posterior tibial tendon and the surrounding structures. If you have not yet undergone a comprehensive evaluation by a specialist, it may be beneficial to seek a second opinion from an orthopedic surgeon or a podiatrist who specializes in foot and ankle disorders.

Treatment Options
Treatment for posterior tibial muscle dysfunction generally starts conservatively and may include:
1. Physical Therapy: A tailored rehabilitation program focusing on strengthening the posterior tibial muscle and improving flexibility can be beneficial. Specific exercises may include:
- Heel raises to strengthen the calf and posterior tibial muscle.

- Resistance band exercises to enhance muscle control.

- Balance and proprioception exercises to improve stability.

2. Orthotics: Custom orthotic devices can help support the arch and redistribute pressure on the foot, alleviating pain and improving function.

3. Activity Modification: Avoiding activities that exacerbate your symptoms, such as prolonged standing or high-impact sports, can help manage pain.

4. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.

5. Surgery: If conservative measures fail and symptoms persist, surgical options may be considered. This could involve repairing or reconstructing the posterior tibial tendon or addressing any structural deformities.

Strength Training
Incorporating strength training into your routine can help improve the function of the posterior tibial muscle. Focus on exercises that target the lower leg and foot, such as:
- Calf Raises: Stand on the edge of a step and raise your heels to strengthen the calf muscles.

- Toe Taps: While seated, tap your toes on the ground to engage the muscles of the foot and ankle.

- Resistance Band Exercises: Use a resistance band to perform ankle dorsiflexion and plantarflexion exercises.

Conclusion
It is essential to work closely with healthcare professionals to develop a comprehensive treatment plan tailored to your specific needs. Given your long history of symptoms and the impact on your daily life, pursuing further evaluation and treatment options is advisable. Engaging in physical therapy and exploring orthotic solutions may provide significant relief and improve your overall function. If conservative treatments do not yield results, discussing surgical options with a specialist may be warranted. Remember, patience and consistency in your rehabilitation efforts are key to recovery.

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