Ankle > Posterior Tibial Tendon Disorder > Treatments

   Immobilization and Orthotics

Treatment Introduction

The first line of treatment for posterior tibial tendon disorders usually is conservative, as physicians try immobilization in a walking cast or cam walker to help decrease the pain in your ankle and see if there is any improvement. Your ankle usually is immobilized for four to six weeks, and you are instructed to use crutches but bear some body weight on your ankle while wearing the cast or cam walker.

   A short leg walking cast wraps around your foot, ankle, and lower leg. Consisting of layers of fiberglass, it starts below your knee and is open around your toes to allow toe movement. Your physician usually rolls a stockinette over your skin, and then a layer of cotton padding. A dry layer of fiberglass is wrapped around your leg and foot. Extra fiberglass strips are wrapped around the sole of your foot. Additional fiberglass layers are applied wet over the first layer.

    When the short leg cast dries, it should immobilize your ankle but allow you to move your toes. It should be snug but not tight.

   A cam walker is a removable boot, made of nylon straps that fasten around your calf and foot. Most cam walkers have an adjustable hinge at the ankle that can be set to allow the range of motion your physician prescribes. The sturdy bottom of the cam walker is rocker shaped, which enables you to walk comfortably.

After about four to six weeks, your physician will examine your ankle. Depending on your response to immobilization, if there is a tear, or if the arch of your foot has collapsed, you may become a candidate for surgery. If your posterior tibial tendon has properly healed, your physician may prescribe orthotic inserts to help support your hindfoot and arch, which provides pain relief. If prescribed, orthotic inserts should be worn in all your shoes.

Crutches are usually prescribed for about four to six weeks while your posterior tibial tendon disorder heals, but you usually can bear weight while using a walking cast. In general, you should continue using your crutches and wearing your cast or cam walker as instructed by your doctor until symptoms dissipate. Your physician usually schedules regular follow-up visits to check your progress. You typically begin partial weight bearing in a brace or cam walker before going back to normal shoe wear. Your physician typically prescribes range of motion exercises for you to perform at home after your cast is removed. Patients generally are instructed to remove their brace or cam walker for a brief period. Physicians typically recommend moving your ankle up, down, and side-to-side. Start with slow movements and do not move your ankle too far in any direction. You usually know early on if the immobilization helped or not. If your previous level of pain and discomfort returns within a week or two of your cast being removed, it is likely that you will need some sort of surgical intervention. Your physician generally evaluates your ankle after four to six weeks, talks with you about your physical and athletic goals, and determines whether regular cardiovascular exercise and everyday weight bearing can sufficiently strengthen your ankle. Athletes and patients who have trouble strengthening their own ankles may require formal physical therapy.

Rehabilitation

It usually takes a few months to restore strength in your ankle, but the rehabilitation period after a posterior tibial tendon disorder is different for everyone. The goal is to strengthen your posterior tibial tendon enough to support your arch and control your foot and ankle motion during activities. When you come out of your cast or cam walker, your ankle may feel stiff, and you should take it easy as you begin walking in normal shoes. You should perform range of motion exercises three times a day. You typically progress to light cardiovascular exercise and then ankle strengthening exercises. If you experience episodes of pain or discomfort while exercising, have your physician examine your ankle. Athletes who want to return to sports as quickly as possible typically undergo supervised physical therapy. Formal physical therapy also may be prescribed for patients who do not make good progress strengthening their ankles on their own. Physical therapy usually involves learning ankle stretching exercises and performing ankle and lower leg strengthening exercises.

To prevent reinjury of your posterior tibial tendon, physicians generally recommend strengthening the leg muscles that help pull your arch up, including the peroneal muscles on the side of your leg and your anterior tibial tendons in the front. Orthotics that support your arch can help to protect your posterior tibial tendon and help relieve tension on the tendon as it transfers weight. You usually can go back to wearing normal shoes, even flat work shoes, but the orthotic insert should be worn at all times. In general, sports that put repetitive stress on your ankles, such as long distance running, may increase your risk of reinjury. If possible, you may want to switch to a sport such as cycling that puts less strain on your ankle. Before engaging in sports and activities, remember to include ankle stretches in your warm-up routine. Most younger patients can recover fully from a posterior tendon disorder and return to a normal level of activity. Middle-aged patients typically can go back to tennis or golf, but physicians generally recommend avoiding high-repetition sports like running.