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You may have noticed a painful swelling in the inner part of your ankle, disrupting your daily activities, especially with riding your favorite bike.
Despite your efforts to ignore it, thinking it will resolve on its own, it still torments you and affects your riding performance.
Posterior tibial tendonitis is one of the many painful medical conditions affecting riders. It causes pain, swelling, and immerse discomfort that affects your riding performance. This article will help you understand what posterior tibial tendonitis is and find out if you should ride your bike with it.
What is posterior tibial tendonitis?
Posterior tibial tendonitis is known as the inflammation of the posterior tibial tendon. The posterior tibial tendon is one of the foot tendons that attaches one of the calf muscles, known as the posterior tibialis muscle, to the medial bones of the foot.
This tendon is particularly prone to overuse or tears, especially while engaging in activities such as cycling. It plays a significant role in supporting the foot arch, and when they become damaged, you notice the absence of the foot arch and the inability to raise your toes while standing on the affected leg.
To recover quickly and prevent it from exacerbating any further, you need to give the affected leg a break which means avoiding cycling, running, and walking because the more you take a step, the more you put pressure on it and the more it impedes your healing.
Here is a summarized overview of the functions of the Posterior tibial tendon:
- It helps to hold your ankle in place.
- It maintains the medial arch of the foot.
- It helps to invert your foot while walking.
- It helps roll your ankle to shift your weight outside of your feet.
What are the causes or risk factors for posterior tibial tendonitis?
Various factors can lead to posterior tibial tendonitis, and most of them tie to the fact they exert an excessive amount of pressure on the tendon. Here are a few causes with detailed explanations of how they result in posterior tibial tendonitis:
- Age & Gender:
Studies show that most women are affected by posterior tibial tendonitis, especially those 40 and older. This happens due to hormonal influence that plays a role in the degeneration of the tendon.
Our tendons are like strands of fibers twisted to make a tough robe, so as one age, some strands degenerate, eventually leading to a tendon tear or an inflamed one.
- Obesity:
The excess fat accumulated in the body puts excessive pressure on the foot. With the posterior tibial tendon being the most affected of all the other tendons, we discover that its tendon fibers start to wear and tear, and when not treated, it ruptures.
- Systemic diseases:
Diseases such as hypertension, diabetes, rheumatic arthritis, and many others are known to affect the nerve and blood supply to this tendon which causes it to degenerate eventually.
- Feet structural abnormalities:
Structural abnormalities put one at risk of posterior tibial tendonitis. This happens due to the overpronation it causes while performing certain activities such as cycling, running, or even walking.
This overpronation is known to exert more stress on the medial aspect of the foot, where the posterior tibial tendon is located.
- Wearing the wrong shoes:
Wearing the wrong pair of shoes can affect your feet by putting pressure on them and eventually affecting the posterior tibial tendon.
- Having weak muscles, bones, or tendons:
This might be due to certain disease conditions, advanced age, or any preexisting injury. When foot muscles such as the posterior tibialis are weak, it eventually affects the tendon and the placement of the feet.
- Over-use of the calf muscles and tendons:
Excessive high-intensity exercises such as running, walking, or cycling is known to put one at risk of a tendon injury. This is because these exercises put pressure on the tendon leading to injury. For this reason, pacing yourself while engaging in these activities is highly important.
- Cycling environment:
The environment where you cycle matters because it affects the amount of energy exerted and the amount of stress put on the muscles.
How severe is posterior tibial tendonitis?
The severity of Posterior tibial tendonitis depends on how far the damage to the tendon is. Posterior tibial tendon damage occurs in stages, which determines the severity of the disease condition.
These stages include:
- Stage 1: Posterior tibial tendon damage and inflammation but no foot defect.
- Stage 2: Elongation of tendon and flattening of the medial arch.
- Stages 3 and 4: A partial or full rupture of the tendon.
Note that before it gets to this stage 4, it first begins with irritation to the outer tendon covering. This leaves the tendon open to damage with continuous wear and tear as it heals. Its thickening and changes in structure weaken it and leave it to a possibility of rupture.
How do you recognize Posterior tibial tendonitis?
You can easily recognize posterior tibial tendonitis by its symptoms which include:
- Pain and swelling: These are two of the main cardinal points of inflammation because of the inflammatory mediators and chemical factors present.
- Loss of foot arch and flat foot: This usually happens when there is a rupture of the tendon that makes the medial arch fall, leaving a flat foot.
- A difficulty tiptoeing: With a ruptured tendon, a loss of foot arch, and a flat foot, it becomes difficult to stand on your toes which signifies that the condition is in its severe state.
How can posterior tibial tendonitis be managed?
The management of posterior tibial tendonitis can either be conservative or non-conservative, and your choice of management definitely depends on its severity. Here are some of the conservative management options:
- The use of NSAID: Nonsteroidal anti-inflammatory drugs such as Aspirin or ibuprofen are preferred instead of steroidal ones because steroidal drugs exacerbate the risk of posterior tibial tendonitis.
- The use of ice packs: Ice packs can help relieve pain, but if you have circulation problems, do not apply this method.
- Using supportive shoes, braces, or orthotics: This provides extra arch support decreasing any stress placed on the posterior tibial tendon.
- Stretching of the calf: Studies say that a calf stretching regime can help the strengthen the tendon. This includes – 3 X 30 secs of standing calf stretch against the wall, both with a straight knee and bent knees, done twice daily.
- Using foam rolling for your calf muscles can help loosen your calf muscle to stress and the posterior tibial tendon.
- Rest: This is advised to aid faster healing. With this condition, you should reduce all activities that would put much pressure on the tendon, such as walking, running, and cycling. If you really need to engage in activities, then cycling is a better alternative to running or walking. Nevertheless, you should cycle on flat surfaces seated on the saddle.
- The use of compression socks: This helps to decrease swelling, and encourage blood flow to the affected leg while aiding better healing.
According to the American academy of orthopedic surgeons, out of these conservative management options, the use of supportive shoes, braces, or orthotics is the most effective way to manage the disease condition before surgical options.
In a case where this condition is severe, it is advised you visit a medical licensed professional for surgical measures. Here are some surgical options:
- Tendon fusion: This is for cases where there is a flat foot. The joint between two bones is removed and left to fuse to maintain normal alignment.
- Tendon Debridement: Surgical operation is done to remove the thickened tissue around the tendon.
- Tendon graft: A badly ruptured tendon may need a new tendon to replace a posterior tibial tendon.
- Tendon repair: The degenerated tendon fibers are removed, and tears are repaired.
How long does it take for posterior tibial tendonitis to heal?
Most sources say that this condition takes about 6 – 12 weeks to heal, but you should expect a total recovery between 6 – 12 months.
What exercises can I engage in for posterior tibial tendonitis?
Although engaging in activities is not encouraged in this condition, there are still some exercises that one can engage in to boost your healing process, and these exercises include:
- Ankle inversions+ resistance bands: This exercise applies stress directly through the posterior tibial tendon, which helps in its remodeling.
Attach the youtube link of the exercise here – Ankle exercise – inversion with band
- Forward step up and downs: This help to strengthen your quads and soleus muscle to help align the leg properly.
Attach the youtube link of the exercise here – Forward Step Up/Step Down
- Seated soleus raised with weight: Just like ankle inversion, this exercise also helps to work on the soleus muscle.
Attach the youtube link of the exercise here – Soleus Calf Raises – seated
Can you still ride your bike with the posterior tibial tendon?
Although sources say that cycling is a better alternative to other activities and you can still engage in them, They also advise you to cut back on all activities to aid faster healing.
But if you must engage in any activity during your recovery stage, then cycling is the right activity. But make sure you cycle on smooth surfaces, sit on the saddle and wear cycling cleats.
Final thoughts
Dealing with Posterior tibial tendonitis is a painful and disturbing experience for every bike rider. You may want to ignore it and keep riding, but it is better you put your health first and take a break from cycling or any other stress-related activity.
Now we have discussed a lot about posterior tibial tendonitis, I will love you to check out our previous blog article on Hamstring tendonitis.
