After the new year the usual January motivation brought an increase of runners into the community, as well as our regular daily outings during lockdown. Couch to 5k will have been accessed no doubt and the attendance of the local park run.
With this increase, we find individuals can experience discomfort in numerous places, especially new runners or those who have had time out (whether for injury or choice) and are returning after a break; this blog will focus on the ankle joint and provide some early signs of what to look for.
Of course injuries can be as individual as you are, so if you think you may have sustained an injury, it is essential you get an assessment. There can could be other reasons for your ankle pain, and so we need to ensure an accurate diagnosis to then plan the best treatment plan.
What is the Tibialis Posterior? #
Anatomy #
The tibialis posterior muscle runs along the inside of our leg, it starts at the back of the tibia (shin bone) and travels along the inside of our ankle turning from muscle into tendon. The tendon then attaches to the inside bones of the foot (Navicular and median cuneiform). The tendon supports the arch of the foot, and provides control of the arch during walking or running, as the arch moves towards the floor. The tendon pulls on the bones in your foot to lock it in place, this provides some rigidity and control of movement.
How do I know the Tibialis Posterior Tendon is injured? #
The tibialis posterior tendon injury is described as a dysfunction (PTTD) and is classified in 4 stages. In this article I will focus on stage 1. Stage 1 can feel like a dull ache on the inside of your foot, this ache can be present in the morning and after periods of activity. If the tendon has been overloaded, you can experience sharp pain into the arch of the foot. The symptoms may start as a subtle pain or dull ache on the inside of the ankle and progress in intensity over time.
The pain can be reported as a line along the outside of the medial malleolus, the bone on the inside of the ankle. Waking first thing in the morning or taking the first few steps of a run, can be particularly painful, once the tendon warms up your pain may improve. Pain can also be present when attempting to raise your heel from the ground and hop.
When a person begins a new sport or activity this can overload the tendon causing a change in the tendon health and a process called tendinopathy occurs. This process is a change in the way the tendon heals after activity. When this occurs, we need to ensure that we load the tendon appropriately, this can be specific to the tibialis posterior or muscles above the tendon which involves strengthening the muscles in your hamstring, quadriceps and glutes.
How do we manage the condition? #
The control of the arch is enhanced by the strength of not only the tibialis posterior but also the muscles higher up in the hip. At Pure Sports Medicine, we have the advantage of working in a multidisciplinary team, and so can utilise the knowledge of our onsite Podiatrist who can offload the tendon. Sports and Exercise Medicine Consultants can provide advice around any further investigations or scans that maybe applicable. Once we have reduced the symptoms we can collaborate with the Strength and Conditioning Coaches to build an in-depth strength programme related to your sport or lifestyle; it is important to build strength around the injured area once pain has decreased or gone entirely.
Physiotherapy intervention at Pure Sports Medicine will involve;
- Discussion around your injury history
- Assessment of your strength
- Identification of your Plyometric strength
- Examination of your balance and control
- A plan to prevent the reoccurrence of the injury and enhance performance.
The tibialis posterior tendon injury (PTTD) will benefit from a multidisciplinary approach to prevent the symptoms progressing and provide immediate symptom relief.
If you are experiencing ankle pain and would like to speak to one of our expert Physiotherapists, please complete the form below.