From the Guidelines
Treatment for a partial tear of the tibialis insertion typically involves rest, eccentric exercise, and analgesics.
Treatment Options
- Rest: prevents ongoing damage, reduces pain, and may promote tendon healing 1
- Eccentric exercise: has proved beneficial in Achilles tendinosus and patellar tendinosus, and may be helpful in other tendinopathies, including tibialis posterior tendon tears 1
- Analgesics: nonsteroidal anti-inflammatory drugs (NSAIDs) effectively relieve tendinopathy pain and may offer additional benefit in acute inflammatory tendonitis 1
Imaging-Guided Interventions
- US-guided intrasheath anesthetic injections: can be concurrently performed with diagnostic US, and may provide relief of symptoms 1
- Tenography: diagnostic and therapeutic ankle tenography can also be considered for evaluation, with one study reporting that 47% of patients had prolonged relief of symptoms 1
Important Considerations
- Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 1
- Tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers 1
From the Research
Treatment Options for Partial Tear of the Tibialis Insertion
- Surgical repair is a viable treatment option for partial tears of the tibialis posterior tendon, as seen in a case report where a 32-year-old male underwent surgical repair with a suture anchor and running whip stitch, resulting in significant improvement in symptoms and function 2.
- Conservative treatment may be adequate for low-demand older patients with partial tears, but surgical treatment may be necessary for active patients to alleviate chronic pain and restore function 3.
- Allograft techniques, such as using an Achilles tendon allograft, can be used to reconstruct chronic degenerative tears of the tibialis anterior tendon, allowing for bone-to-bone fixation and earlier full weight bearing 3.
- Partial rupture of the tibialis posterior tendon can be difficult to diagnose, especially in cases where it is associated with a closed medial malleolar fracture, and may require careful evaluation and imaging studies to confirm the diagnosis 4.
- Surgical treatment for tibialis anterior tendinosis, including partial tears, can involve debridement and direct repair, with or without augmentation, and can result in improved function and satisfaction for patients 5.
- Computed tomography (CT) scans can be used to evaluate the extent of tendon injury and guide surgical treatment, with a high degree of accuracy in diagnosing partial and complete ruptures of the posterior tibial tendon 6.