Posterior tibial tendonitis is an inflammation of the tendon. The tendon represents an extension from the muscle to the bone, through which it exerts mechanical action inserting and mobilizing the joints. The tendon has elastic properties that allow it to modulate the action of muscle and reduce fracture risk in case of rapid violent muscle contractions.
The posterior tendonitis involves the rotulian tendon and the cvadricipital tendon (cvadricipital tendonitis). In rare cases the ischio-Gambier muscles are affected. Finally, the wide fascia syndrome issue is a part of the posterial tibial tendonitis.
The causes for posterior tibial tendonitis are:
Sports activities are the most often causes for posterior tibial tendonitis, for various reasons. Most often repetitive and excessive actions generated posterior tibial tendonitis. These excessive tractions of the tendon may occur in a brutal manner, during a jump or a football game or a progressive manner, by repeated movements.
Sometimes the cause of posterior tibial tendonitis is a direct shock to the knee, particularly in the tibial bone.
More rarely, posterior tibial tendonitis is a tendon rubbing against neighboring anatomical structure: in this case it is the wide fascia, which may conflict with the prominent bone located in the lower extremity of the tibia.
Posterior tibial tendonitis is actually a partial tear of tendon fibers that is accompanied by swelling. Evolution of these lesions may take several months but, contrary to what you might think, complete rest is not necessary for tendon injuries to be cured.
Manifestations posterior tibial tendonitis
Posterior tibial tendonitis is responsible for pain. This pain, located in the concerned tibial tendon region, is variable:
In their appearance way – most often progressively less brutal
In the circumstances of occurrence – from permanent pain to pain that does not appear until the effort
The posterior tibial tendonitis evolution can take several months. It may develop a tendency to spontaneous healing or it can persist and becomes chronic. Occurrence of tendon rupture in the event of posterior tibial tendonitis is a rare but serious. It is manifested by extreme pain at a violent jump or a brutal maneuver, with complete functional breakdown and impotence.
Posterior tibial tendonitis diagnosis is based on:
Clinical examination and palpation that can trigger a particular net tendon pain, especially in the peak rotulian kneecap tendon
Radiography may reveal a thickening of the tendon, tendon calcifications
Ultrasound can visualize node tendonitis
MRI exam is extremely powerful in the study posterior tibial tendonitis
Full rest is rarely indicated. In fact, it shows more disadvantages than advantages. A full rest favors muscle atrophy and it does not shorten the recovery time. It is preferred a relatively adjusted rest to the level of pain. Walking with crutches or a knee orthesis can be effective.
Inflammatory treatments that are not cortisone based have a variable action on the posterior tibial tendonitis. They are indicated in the acute phase, unlike the chronic phase, in which they are less effective. They are found in pharmacies in the form of tablets, gels or patches.
Physiotherapy can be very effective and important treatment posterior tibial tendonitis. Ultrasound current analgesic, laser, massage and others are used during this treatment depending on the disease’s level.
Surgery is very rare. It may be necessary in chronic cases unresponsive to medical treatment.
Pathophysiology for posterior tibial tendonitis
The triggers of posterior tibial tendonitis include usage, intense, repeated and sustained exercise, sustained extreme positions and insufficient recovery after physical activity, vibration and cold temperatures. Posterior tibial tendonitis develops in some patients after several days to six months after the completion of a course of therapy. Pathological mechanisms of this tendonitis are multi factorial. Studies show ischemic, toxic and degenerative changes.
The remodeling change activity is associated with the outbreak of posterior tibial tendonitis. Major changes include increased expression of collagen III. These changes are consistent in the repair process, but can also be an adaptation response to mechanical load. Repeated tension and minor strain, are also considered causes for the posterior tibial tendonitis.