Muscle Power Deficits
Patients with posterior tibialis tendinopathy typically present to clinic with diffuse medial ankle/foot pain often with insidious onset. In more severe cases pain can also radiate into the medial calf region!
For more clinical findings click here!
Anatomy
Image via Complete Anatomy by 3D4 Medical
Midfoot Mobility
Remember, during patient assessment, it is imperative to examine up and down the kinetic chain in order to gain a more well-rounded understanding of the patient’s pathology. That being said, mid foot mobility is still something that should be addressed!
(Click image to watch 1-2 minute video)
Posterior Tibialis Assessment
In order to better rule in the possibility of posterior tibialis tendinopathy, the therapist should elongate, contract, and palpate the muscle belly and tendon looking for reproduction of symptoms. Here is an example of how to properly elongate! (Click image to watch 1-2 minute video)
Treatment
Often, lack of dorsiflexion range of motion can result in compensatory mechanisms through the midfoot contributing to irritation of the posterior tibialis tendon. A high-velocity low amplitude thrust to the talocrural joint can help improve this range of motion deficit! (Click image to watch 1-2 minute video)
Therapeutic Exercise
Motor coordination both proximally and distally can contribute to excessive pronation. A squat assessment can also double as a therapeutic exercise by cueing the patient to maintain a neutral mid foot position while performing the movement! (Click image to watch 1-2 minute video)