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Advice for Tib Post Tendinopathy that doesn't want to react to treatment

Tib Post teninopathy can cause a lot of pain on the inside of your ankle and foot and be notoriously slow to react to treatment. In this article I’ll share some tips that has made the biggest differences for my patients who had "difficult to fix" cases of this condition. I’ve previously done a livestream where I explained the full array of treatments for Tib Post tendinopthy and you may find that video useful as well.



In this article:

  • Be careful of exercises

  • Shoes matter

  • Time on feet

  • What if it still doesn’t work?

Here's the video recording of the livestream I did about this:



Be careful of exercises


We all know by now that research has shown that exercise is a very important part of treating tendinopathies. But not all tendons react in the same way. In my experience, I’ve often found that my patients do better if they stay away from strength training exercises and stretches that specifically target the Tib Post tendon and I think it’s because compression plays such a large part in how this injury is created.


The same appears to be true for other tendons in the body that experiences a high level of compression. Take for instance insertional Achilles tendinopathy vs. mid-portion Achilles tendinopathy. For insertional Achilles tendinopathy you have to be really conservative with the strength training and often first off-load the tendon by lifting a patient’s heel in their shoes etc. to stop the tendon compressing against the bone. But patients with mid portion Achilles tendinopathy can usually immediately jump in to doing strength training because that part of the tendon doesn’t make contact with the bone.


The Tip Post tendon gets compressed against the bones as it wraps around the inside of the ankle and foot. This is normal and its job is to help control how much your foot rolls in (pronates). Patients who develop Tib Post tendinopathy usually does so because their feet turn in excessively, causing the tendon to over-work but also to compress excessively against the bones of the foot.


The typical stretches and strengthening exercises that patients are prescribed for Tip Post tendinopathy also causes the tendon to compress against the bones and I find that many of my patients can’t tolerate them for a very long time.


What can you do? Start with exercises that strengthen the foot arch but does not cause tendon compression. Rather than stretching it, foam roll your calf if it’s feeling tight. I demonstrate examples of this in the video above.


Shoes matter


Shoes are important for 2 reasons:

  1. Supportive shoes that includes arch support will act as a “crutch” for your tendon and allow it to rest and recover. It is difficult to find shoes with enough support so I usually get my patients to also invest in some orthotics. Look for firm but slightly softer insoles because if they press on the tendon in the wrong way, they can cause extra compression and keep the pain going. It's not rocket science! If they feel comfortable, they're good - if they hurt you, they're not right for you.

  2. If you tie your shoes quite tight, even that low level of compression can sometimes be enough to irritate your tendon and cause it to ache. Some of my patients, myself included, have found it useful to really loosen their laces during the first period of recovery.

Time on feet


Standing for extended periods of time can often be even more aggravating to your Tip Post tendon than walking. Yes, the tendon helps to control pronation when you walk, but it also carries load when you’re just standing as it still helps to support your arch. You have to decrease this load to a level that doesn't irritate your tendon.


I’ve had first-hand experience of this when I developed this condition in both my feet! As a physio I sometimes spend up to 12 hours on my feet while treating patients and I found that all the progress that I made in the days where I was spending less time on my feet, were wiped out by the days when I was forced to walk and stand a lot.


I eventually realised that I had to make a change if I wanted to get rid of my problem, but cutting my work hours was not an option. Instead I made sure that I sat down at every opportunity I got. It’s amazing how much hands-on physio you can actually do while sitting down! Also, we tend to stand when we chat to colleagues or when we’re waiting for the bus etc. – all of this I adapted and if I couldn’t sit down I would try and perch against something or take some of my weight on my arms.


This may sound extreme, but it was the thing that made the biggest difference to my recovery. Well, that and finally figuring out that I had to loosen my laces! Please don’t think that this means that you’ve got to be totally inactive. During this time I still cycled and swam as much as I wanted. It was just time on feet that I had to restrict.


What if it still doesn’t work?


See if you can get a referral to see a sports physician. They can do an ultrasound scan of your tendon and determine exactly what is going on – sometimes a tear of the Tib Post tendon can feel very similar to a tendinopathy but they may require slightly different treatments. Sport physicians also have lots of other treatment options available. Some patients may benefit from injections while for others shockwave may be the better choice.


You may also find it useful to watch the video I did previously where I explained the normal treatment for Tib Post tendinopathy.


Let me know if you have any questions. You’re also welcome to consult me online via video call for an assessment of your injury and a bespoke treatment plan.

Best wishes

Maryke


About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.



References:

  1. Cook, J. L. and C. R. Purdam (2009). "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy." British Journal of Sports Medicine 43(6): 409-416.

  2. Scott, A., et al. (2013). "Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012." British Journal of Sports Medicine 47(9): 536-544.

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