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201: TIBIALIS POSTERIOR TENDINITIS

Eric Shamus, PhD, DPT, PT, CSCS; Christina Machuca, DPT, CSCS

CONDITION/DISORDER SYNONYMS

  • Medial shin splints

  • Tibialis posterior tendonitis

ICD-9-CM CODE1

  • 844.9 Sprains and strains of unspecified site of knee and leg

ICD-10-CM CODE2

  • S86.919A Strain of unspecified muscle(s) and tendon(s) at lower leg level, unspecified leg, initial encounter

PREFERRED PRACTICE PATTERN3

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

PATIENT PRESENTATION

A 16-year-old girl presents with right medial shin pain. She indicates that she began running cross country 6 weeks ago on the side walk around her school. The patient is wearing soft flexible sneakers. She complains that it is a little sore when she starts running. She feels fine through the middle of the run and really bothers her when she is done running. The X-ray was negative for a stress fracture. She is a late midstance pronator with a forefoot varus and weak hip external rotators.

KEY FEATURES

Description

  • Lower medial leg pain from an overuse activity

  • Pain is localized in the posterior medial aspects of the tibia

  • Attributed to muscles of the lower extremities being overloaded or by biomechanical irregularities

  • Recurring dull ache along the posterior medial aspect of the lower tibia

Essentials of Diagnosis

  • Diagnosis is usually made by clinical examination

  • Pain increases with active plantar flexion and when the tibialis posterior muscle is stretched into dorsiflexion

  • Muscle length and strength imbalances, especially a tight gastrocnemius–soleus muscle group

General Considerations

  • Tendinopathy

  • Periostitis

  • Dysfunction of the tibialis posterior and soleus muscles

  • Results from repeated activity without proper conditioning or allowing enough recovery time between activities

  • Pain with repetitive activity, when the involved musculotendinous unit is stretched

FIGURE 201-1

Tibialis posterior (L5, S1; tibial nerve). The plantar-flexed foot is inverted against resistance applied by gripping the foot with the examiner’s hand. (From Waxman SG. Clinical Neuroanatomy. 26th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Demographics

  • Beginning runners with poor lower-extremity muscle control; increased pronation

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Tightness in gastrocnemius, soleus, and plantar muscles

  • Pain: Mild to severe with weight-bearing activities and gait

  • Described as a dull ache to the lower extremities

  • Point tenderness to the tibia at posterior medial aspect

  • Muscle guarding with passive movement

Functional Implications

  • Pain with standing or during activity

  • Inability of injured lower extremity to fully weight bear

  • Pain with closed chain ankle movements (i.e., driving)

Possible Contributing Causes

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