Posterior tibialis tendinitis or muscle strain

Findings

Tenderness over the medial, deep compartment, close to the tibia, which is worse on resisted testing of the posterior tibialis. This ache may present early in cases of functional overpronation, but it usually does not present alone, being accompanied by the tenderness of posterior tibialis tenosynovitis around the ankle or foot. It may also present as part of the medial tibial syndrome.

Cause

An overload of the posterior tibialis muscle, which may be strained, secondary to overpronation, of the pain may result from a compartment syndrome effect on the muscle. This problem may be seen during the rehabilitation of Achilles tendons. The athlete starts rehabilitation running but instead of running through the foot, via the Achilles, he or she runs with the foot externally rotated to protect the Achilles from load, and so runs in such a way that the posterior tibialis is providing the propulsion.

Treatment

Correction of the technique and corrective orthotics is curative.

Sports

This is an injury that is common in the group of anatomical, or functional, overpronators. It is unlikely to be camber or hill running induced, much more likely to be caused by a sudden increase in mileage, pace, bend running, or dancing. Walking and edging the foot along the side of a hill, for a long while, can strain the muscle. This injury can be induced during rehabilitation.

Probably, the medial tibial stress syndromes, stress fractures and posterior tibial muscle strains have a similar cause of functional overpronation, plus an increase in loading rate to which the tissues cannot adapt.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English