Tibialis Posterior: An Really Important Muscle

The Tibialis Posterior, a muscle that sounds like the cross between a bone, the Tibia and a functional position – Posterior. Surely this can’t be that an important muscle within the lower limb?

Believe it or not this muscle plays a major supporting role in the foot. Think of the office manager of a small business, that has their finger in all aspects of the company and may directly or indirectly have a large effect on the running of the company. Even though their name may not be up in lights or take all the accolades! This muscle is akin to the office manager within the foot. This muscle has a vital role to play when we walk being the foot’s main dynamic stabliser. You can read some research about that here.

Let’s have a look at a few things about this important muscle within the foot…

  1. What’s is it and what’s it’s role within the foot?
  2. Tibialis Posterior Tendon Dysfunction.
  3. What can we do about it?

What is the Tibialis Posteria?

The Tibialis Posterior, sometimes referred to by anatomists as the ‘Hussy’ of the foot. It’s called this because of it’s many attachments within the foot. This muscle starts from just below the knee on both the Tibia and Fibula plus the membrane that joins between these two bones. When it heads down the lower limb it tucks behind the middle ankle bone which is critically important for it’s role within the foot to act as a pulley. After it creeps behind the ankle it joins to almost all of the bones between your heel bone and your metatarsals.

Foot Anatomy

What is the role of the Tibialis Posteria?

Joining to all these bones within the mid foot makes this muscle really crucial role in moving the foot inwards, and upholding the integrity of the arch! It does this by the simple mechanics of using the ankle bone in the middle of the body as the pulley. Moving the foot into ‘inversion’ during walking.

As you can imagine when a muscle like this starts to falter, the integrity of the arch is questioned. It’s a gradual process and one that you may not notice looking at your feet every day. However this tendon failing is the most common cause of leading to the adult flat foot.

 

Related Article: Foot Problems & How a Podiatrist Can Help

Tibialis Posterior Tendon Dysfunction

People who have this injury will commonly have pain running along the inside of their foot. They may have trouble standing on their tippy toes or equally walking up or down hill and it will worsen with activity.  The main risk factors for this are diabetes, hypertension, obesity, local steroid injection or previous surgery.

Clinically the degeneration of this tendon is progressive and will happen over time and is classified into four stages which you can read more about here. Lets explain it in it’s stages briefly….

Stages of Tibialas Posterior Dysfunction

Stage 1

At this stage the tendon will be inflamed and intact. Clinically there will be no deformity, and generally there will be no pain during walking. Some patients may experience pain while running.

Heel raise

 

Stage 2

The tendon is ruptured and non functional. There will be the start if the collapse of the arch able to be seen with x-ray at this point. Clinically you won’t be able to stand on one foot and rise to stand on your toes. There will be pain when walking and running at this stage.

Stage 3

Deformity has set in at this stage and your foot will become fixed rigid and inflexible. You will have osteoarthritis in the joint below your ankle.

Stage 4

At this stage the ankle joint will become involved and there will be degeneration that is taking place. Walking will have changed significantly due to the lack of integrity in the arch of your foot.

Flat Feet

What can we do about it Tibialis Posterior Dysfunction?

Reading about the progression of this injury the prognosis at stage three and four sounds quite bleak. However if the dysfunction of the tendon is treated early it ca quite easily be treated! What are the things that your podiatrist will educate and advise you to do…

Shoes – One of the most important things that we can do for our foot health is supportive shoes! Many shoe manufactures will cut corners on support within a shoe because of production costs. Always make sure your shoe is of good integrity and check with your podiatrist if you’re unsure about this.

Running shoes

Orthotics – These devices are individually prescribed and designed to help support your arch and foot function. There has been another blog post written here which answers some of the more common questions.

Rehabilitation – The muscle will need to be strengthened. More often than not the muscle will present with our various instabilities of the surrounding muscles. Obviously your podiatrist will be able to direct the rehabilitation program to your specific needs.

Immobilisation – Depending on what stage of the tendon dysfunction that you are in you may need to have a period where the tendon can rest and recover. This may be in the case of a CAM walker or an equivalent immobilisation device.

Surgery – When all avenue’s have been pursued, surgery is the option that a patient would need to look at if all else fails. Generally surgery on Posterior Tibial Tendon Dysfunction requires a mid foot reconstruction. It would require some time off you feet because of the recovery. Hopefully you have seen a Podiatrist before the stage that surgery is required!!

 

References

  1. Semple, R., Murley, G., Woodburn, J. and Turner, D. (2009). Tibialis posterior in health and disease: a review of structure and function with specific reference to electromyographic studies. Journal of Foot and Ankle Research, 2(1).
  2. Carmody, D., Bubra, P., Keighley, G. and Rateesh, S. (2015). Posterior tibial tendon dysfunction: An overlooked cause of foot deformity. Journal of Family Medicine and Primary Care, 4(1), p.26.

 

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