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