Tuesday, December 5, 2023

Pain On The Inside Of The Ankle

Posterior Tibial Tendon Injury

Ankle tendonitis – causes, symptoms, and recovery explained

by myDr | Exercise & Fitness

Posterior tibial tendon injury occurs when the posterior tibial tendon becomes inflamed or torn.

The posterior tibial tendon provides support to the arch of the foot and gives stability when walking. Also known as the tibialis posterior tendon, it attaches the calf muscle to the bones of the inside of the foot. The tendon is located at the back of the leg and passes underneath the inside knob of the ankle bone and then inserts onto a small bone in the arch of the foot called the navicular. The posterior tibial tendon helps to invert the foot . Posterior tibial tendonitis injury may involve inflammation, overstretching, or even rupture of the tendon.

What Is Posterior Tibial Dysfunction

Posterior tibial tendon dysfunction is characterized by pain and at times swelling along the medial aspect of the foot and behind the medial malleolus .

The pain is usually aggravated by prolonged standing, walking, running, or jumping.

1. Posterior Tibial Muscle Function:

The posterior tibial muscle and tendon help stabilize the ankle.

It is responsible for pointing the foot in and down and elevating the arch

2. Posterior Tibial Muscle and its role in Flat Foot deformity:

The tibialis posterior tendon is also the primary dynamic stabiliser of the medial longitudinal arch

Without the tibialis posterior, the other ligaments and joint capsules gradually become weak, and thus flatfoot develops.

This later action allows the gastrocnemius muscle to act with much greater efficiency during gait. Furthermore, without the tibialis posterior the gastrocnemius is unable to act efficiently, and therefore gait and balance are seriously affected.

How Do I Know The Tibialis Posterior Tendon Is Injured#

The tibialis posterior tendon injury is described as a dysfunction and is classified in 4 stages. In this article I will focus on stage 1. Stage 1 can feel like a dull ache on the inside of your foot, this ache can be present in the morning and after periods of activity. If the tendon has been overloaded, you can experience sharp pain into the arch of the foot. The symptoms may start as a subtle pain or dull ache on the inside of the ankle and progress in intensity over time.

The pain can be reported as a line along the outside of the medial malleolus, the bone on the inside of the ankle. Waking first thing in the morning or taking the first few steps of a run, can be particularly painful, once the tendon warms up your pain may improve. Pain can also be present when attempting to raise your heel from the ground and hop.

When a person begins a new sport or activity this can overload the tendon causing a change in the tendon health and a process called tendinopathy occurs. This process is a change in the way the tendon heals after activity. When this occurs, we need to ensure that we load the tendon appropriately, this can be specific to the tibialis posterior or muscles above the tendon which involves strengthening the muscles in your hamstring, quadriceps and glutes.

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What Causes Inner Ankle Pain And How To Get The Best Treatment

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Ankle bears your bodys tremendous weight, especially when you are jogging or running. Inner ankle pain is a common problem that may last for more than a day.

It may sound an alarm against something serious, and in such a case, immediate doctors help should be taken.

Inside ankle pain tends to become a barrier in the path of normal livelihood.

It can cause serious restrictions in movement as well as excruciating pain, one thats very difficult to deal with.

During this time, one should avoid all sorts of exercises or any activities that require one to put pressure or stress on their ankles.

Also, avoid physical activities like jogging and running, as these would complicate things.

Anatomy Why Is The Posterior Tibialis Tendon Prone To Injury

Medial Ankle Pain: Tarsal Tunnel Syndrome

Figure 1 Posterior Tibial Tendon

The posterior tibial tendon starts deep in the calf and runs behind the ankle bone on the inside of the ankle. The tendon continues along towards the foot and attaches into multiple locations on the inside of the foot and the bottom of the arch.

A tremendous amount of tension and stress is placed is on this tendon with every step as it helps to maintain and recreate the arch of the foot. The amount of stress on the tendon varies from person to person depending on the shape of their foot . It would seem that only a flatfooted person would get posterior tibial tendonitis is more common in flatfooted people, but it can occur in anyone.

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Common Causes Of Ankle Pain

If you are experiencing ankle pain, there is a good chance it may be due to one of these common causes.


An ankle sprain is an injury of one or more ligaments . Ankle sprains may happen from stepping off a curb, walking on an uneven surface, falling, or playing a sport like tennis or basketball where a rapid change in direction causes the ankle to roll or twist inward.

Most commonly, ankle sprains happen in the anterior talofibular ligament , which is on the outside of the ankle. Symptoms include throbbing pain on the outside of the ankle, along with swelling, bruising, and/or a feeling that the joint may give out.

Medial sprains, involving the ligaments on the inside of the ankle, occur much less frequently. Medial ankle sprains cause throbbing pain on the inside of the ankle and result from the ankle rolling outward.

High ankle sprains are also unusual. They cause pain above the ankle, where ligaments connect the two lower leg bones. They are most common in people who play impact sports like hockey or football.


Tendonitis occurs when the tendons, which attach muscle to bone, become irritated and inflamed. There are three types of tendonitis that can happen in the ankle: peroneal tedonitis, posterior tibial tendonitis, and Achilles tendonitis.

Peroneal tendonitis is inflammation of the peroneal longus or peroneal brevis tendons. These two tendons run along the outside of the ankle joint.


Bone Breaks

Bone Bruises

Treatment For Tarsal Tunnel Syndrome

Treatment for Tarsal Tunnel Syndrome has to be specifically designed for you. It has to address the reason why YOUR nerve is being compressed. Is it your foots position or thickened tendons or maybe an activity that youre doing on a regular basis that is causing your problem?

Conservative treatment consisting of soft tissue massage, dry needling and stretches can work well for some. Just be careful calf stretches can sometimes make the pain feel worse. Orthotics or supportive insoles can also be useful to help reduce over-pronation. Strengthening the muscles that support the foot and leg may help for others.

In cases that does not respond to conservative treatment, corticosteroid injections and immobilising the foot for a period in a boot may work. Surgery, where they release the nerve, is also an option and can give good results. However, that too doesnt work for everyone.

Need more help with your injury? Youre welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

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Benefits Of Keeping Active

Keeping active is an essential part of your treatment and recovery and is the single best thing you can do for your health.

Being physically active can:

  • maintain your current levels of fitness even if you have to modify what you normally do, any activity is better than none
  • keep your other muscles and joints strong and flexible
  • prevent a recurrence of the problem

Avoid sports or heavy lifting until you have less discomfort and good movement. Remember to warm up before sports.

What Tendon Is On The Inside Of Your Ankle

Posterior Tibial Tendinitis Evaluation with Paul Marquis PT

The calf muscles are attached to the bones of the inside of the foot. The anklebone has an inside knob of the medial phalanx, which is located at the back of the leg. The tibia and fibula are the two bones that make up the lower leg.

They are joined together by a tendon that runs from the knee down through the shin bone and into the heel bone. This tendon attaches to a bone called the calcaneus, which is a small bone that sits on top of a larger bone, the metatarsophalangeal joint. It is the MTP joint that is responsible for supporting the weight of your foot on the ground.

When you step on a hard surface, such as concrete or asphalt, this joint moves up and down with the force of gravity. As a result, when you walk on hard surfaces, your ankle and foot tend to move in the same direction. If this is not the case, you may experience pain or discomfort in your toes, heel, and/or ankle.

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Other Possible Treatment Options

Since posterior tibial tendon dysfunction is so sparsely researched, there is not much information on additional treatments. Icing often is strongly recommended, both by runners and in the scientific literature.5Foam rolling your calf muscles should help too, since loosening your calves up will reduce stress on your posterior tibial tendon.

If these general exercises arent helping, you might want to see aphysical therapist who can identify whether you have any other strength or flexibility deficits that are contributing to your posterior tibial tendon dysfunction.

Whats the bottom line?

If you still havent improved after several months of conservative treatment, you should consult with a trusted podiatrist or orthopedist and discuss the possibility of surgery. There are dozens of different surgical techniques to attempt to repair a damaged or ruptured posterior tibial tendon, so it definitely pays off to see a doctor with a lot of experience.

What Are The Symptoms Associated With Inside Ankle Pain

The severity of inside ankle pain depends on how damaged the medial deltoid ligament is. The following symptoms indicate inside ankle pain:

  • Pain felt in the medial portion of the ankle with movement.
  • Stiffness and swelling of the ankle joint.
  • Crepitus or clicking sounds while moving.
  • Tenderness and bruising on the inside of the ankle.
  • Instability of the foot while walking or moving .

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What Is Happening Am I Making It Worse

Though its not a well-known running injuryonly the 26th most common injury, according to one study1posterior tibial tendon dysfunction can be extremely difficult to get rid of.

Worse, if not addressed, it has the tendency to become progressively worse over time. In some cases, it can become so severe that your foots arch collapses, leaving you with a permanently deformed foot.

It gets worse:

As posterior tibial tendon dysfunction worsens, your arch height drops and your foot becomes more pronated when you put weight on it because the tendon can no longer provide adequate support.

As a result, the tension on the posterior tibial tendon increases. This creates a vicious cycle where a lower arch and increased pronation increase stress on the posterior tibial tendon, which in turn sustains more damage, leading to even greater arch collapse and pronation, and the cycle starts again.2

What Can Cause It

Pin on Foot Pain

Tarsal Tunnel Syndrome can be caused by anything that decreases the space and therefore increases the pressure inside the tarsal tunnel. Some of the most common causes include:

  • Changes in the foot anatomy e.g. when the foot arch flattens.

  • Excessive pronation of the foot

  • Thickening of retinaculum or the tendons that run inside the tunnel e.g. thickening of the tibialis posterior tendon when you have Tib Post Tendinopathy

  • Cysts or growths inside the tunnel

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Inner Ankle Pain Treatment

The treatment method for these types of inner ankle pain is driven by what has caused the pain and your doctor can help you know about the best treatment that would work for you after diagnosing your problem carefully.

If inner ankle bone pain is caused by an injury, the following tips can help effectively manage the condition.

But care that you should follow these after consulting with your doctor.

1- Rest:

Inner ankle pain and swelling can be managed by taking a good amount of rest.

Also, one should avoid indulging in sporting activities until pain subsides.

If the injury is mild, pain can go away with rest alone.

2- Ice:

If pain in the inner ankle is accompanied by swelling, it is recommended to apply ice packs to the affected area.

Wrap ice in a towel and compress it against the affected area. Apply for 15 minutes four times a day.

Avoid rubbing ice for a long period on the affected area as it can damage tissue.

3- Heat:

The application of heating pads on the affected area also helps in dealing with chronic ankle pain.

The heat helps in relaxing and loosening tissues while stimulating blood flow in the aching ankle area.

The pain that occurs due to overuse injuries can also be treated by ankle pain ineffectual way.

4- Elevation:

Keeping the affected ankle at a higher level than your heart helps reduce the swelling and pain in the ankle.

So, place two pillows or a leg wedge under your ankle while sitting or sleeping.

5- Medication:

What Is Posterior Tibial Tendinitis

Though not as infamous as plantar fasciitis or ankle sprains, posterior tibial tendonitis is a relatively common ankle injury in runners.

Heres the truth.

PTTD is one of the most common issues of the foot and ankle.

This injury occurs when the posterior tibial tendon is inflamed, partially ruptured, or torn, causing tenderness and pain around the bony structure of the inside of the ankle.

But, what is the posterior tibial tendon anyway?

Time for anatomy 101.

The posterior tibial tendon is one of the most crucial tendons in your lower legs.

Located on the inside of the lower leg, the posterior tibial tendon connects the calf muscles to the ones on the inside of the foot and.

Check Image.

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What Exercise Is Good For Ankle Pain

The ankle rotation raises your foot about 20 inches off the floor. With your toe up, move your foot to the left and back to the right. Return to the starting position after holding for 10 seconds. For a total of 60 seconds, you must repeat 20 times.

Leg Raises Raise the leg up to a 90-degree angle with the knee bent at 90 degrees and the toes pointed toward the ceiling. Keeping the back straight, raise the hip up until it is parallel to your spine, then lower it back down to its original position and repeat for the prescribed number of repetitions.

See A Sports Medicine Doctor

The Exam for Ankle & Foot Pain – Stanford Medicine 25

As weve detailed, people who are extremely active or participate in a variety of sports are particularly prone to developing inside ankle pain.

Scheduling an appointment with a sports medicine doctor before the peak season of your activities is important in ensuring your conditioning and form are in order.

If you have high arches or flat feet, these doctors can also recommend the right orthotic shoes to prevent injury.

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What It Feels Like

We all have slight differences in where the tibial nerve runs and also at what level it splits into the medial and lateral plantar nerves. As a result you may find that where you feel your pain or symptoms is in a different area than other people with this condition.

You can experience pain, throbbing, numbness, tingling or funny sensations on the inside of the ankle or underneath your foot, but it can also shoot up into your calf. The pain from Tarsal Tunnel Syndrome can easily be misdiagnosed as plantar fasciitis, because it can cause a similar pain under the heel.

Nerve root irritation involving the L4, L5 or S1 nerve roots can also refer pain into that area. You can even have a double crush injury where the nerve can be stuck higher up the leg or in the lower back, causing it to pull extra tight around the ankle when you walk. This is why it is useful to consult a clinician who can listen to all your symptoms and test everything from your lower back down to your ankle.

How Is Inside Ankle Pain Graded

Medial ankle pain is primarily felt inside the ankle is classified into grades based on the severity of the injury:

Pain occurs due to the microscopic disruption and stretching of the deltoid ligament. The medial stability of the ankle is compromised due to pain.

Partial tearing and stretching of the medial deltoid joint are seen on MRI. Pain compromises the stability of the medial ankle.

The medial deltoid ligament is completely torn and ruptured, resulting in inside ankle pain-causing instability of the medial ankle.

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Why Choose University Foot And Ankle Institute For Your Foot And Ankle Care

No matter what condition is causing your inner ankle pain, the staff of University Foot and Ankle is ready, willing, and able to relieve that pain. Our nationally recognized foot and ankle specialists offer the most advanced podiatric care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

For more information or to schedule a consultation online, please call 736-6001 or visit us at www.footankleinstitute.com.

At UFAI, we take our patients safety seriously. Our clinics and surgery centers Covid-19 patient safety procedures exceed all CDC recommendations during this coronavirus pandemic. Masks are required in our institutes at all times.

We are conveniently located throughout Southern California and the Los Angeles area. Our doctors are available at locations in or near: Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California.

Understanding Painful Inner Ankle And Ankle Arthritis

Ankle Sprains in Youth: This Patient Page discusses how to treat ankle ...

Runners and football players are prone to wearing down and injuring their medial ankle. Running in sharp turns strains the inner ankle, causing wear and tear, and one direct kick to your inner ankle is all it takes to trigger tibialis posterior syndrome.

At DeLoor Podiatry, weve had patients who thought the medial ankle itselfthe cartilage or ligaments of the joint is to blame, but it was the damaged tibialis posterior muscle and tendon, or post-traumatic arthritis.

Post-traumatic arthritis involves previous injury coming back to haunt the patient, which is also common among active runners and athletes who ignored inner ankle sprains or general discomfort in their ankles.

Osteoarthritis is common to everyone who ever used their joints. Its wear and tear, a natural result of our bones and joints degenerating as we grow older. BUT bone and joint degeneration are also caused by injury improperly treated and rehabilitated.

Cartilage, the cushion in between joints, gets damaged, wears down, becomes frayed. Pieces break off, or the bone becomes roughened due to rubbing together. All this causes inflammation, pain and disability. You affected ankle has a much decreased tolerance for walking and bearing weight.

Post-traumatic arthritis is almost identical to osteoarthritis. It may take years to appear, but when it does, the most common is foot and ankle arthritis, post-trauma.

Heres why you should immediately go to a podiatrist and never leave a painful inner ankle untreated:

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