From the Guidelines
Treatment for pediatric posterior tibial tendonitis primarily involves conservative measures, with a focus on relative rest to decrease repetitive loading of the damaged tendon, as recommended by the American Family Physician in 2005 1. The goal of treatment is to reduce pain and inflammation, promote healing, and prevent recurrence.
- Rest the affected foot and ankle, avoiding activities that worsen pain for 2-4 weeks.
- Apply ice to the painful area for 15-20 minutes several times daily, especially after activity.
- Over-the-counter NSAIDs like ibuprofen (10mg/kg/dose every 6-8 hours, not exceeding 40mg/kg/day) or naproxen (5-7mg/kg every 8-12 hours) can help manage pain and inflammation, as suggested by various studies 1.
- Physical therapy focusing on stretching and strengthening exercises for the posterior tibial tendon and surrounding muscles is essential for recovery and preventing recurrence.
- Supportive footwear with good arch support or custom orthotic inserts can reduce strain on the tendon. In some cases, a short period of immobilization with a walking boot or ankle brace may be necessary for severe cases. Most children respond well to these conservative treatments within 4-6 weeks. This condition occurs when the posterior tibial tendon, which supports the arch and helps turn the foot inward, becomes inflamed due to overuse, improper footwear, or biomechanical issues like flat feet. Early intervention is important to prevent progression to more serious tendon dysfunction. If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may be considered, as outlined in the American College of Foot and Ankle Surgeons' guidelines 1.
From the Research
Pediatric Posterior Tibia Tendonitis Treatment
- The provided studies do not specifically focus on pediatric posterior tibia tendonitis treatment, but rather on adult acquired flatfoot deformity and posterior tibialis tendon dysfunction in general populations 2, 3, 4, 5, 6.
- However, the principles of treatment for posterior tibialis tendon dysfunction, such as reducing inflammation, minimizing fibrosis buildup, and controlling pronatory force, may be applicable to pediatric cases as well 3.
- Conservative treatment options, including orthotics and exercise programs, are commonly recommended for adult patients with posterior tibialis tendon dysfunction, but the optimal treatment approach for pediatric patients is not clearly established 2, 6.
- A clinical guideline for the conservative management of tibialis posterior tendon dysfunction was developed using a consensus development group, but the lack of national consensus regarding treatment approaches may limit the transferability of this guideline to other localities 6.
- Further research is needed to investigate the epidemiology, diagnosis, and treatment of posterior tibialis tendon dysfunction in pediatric populations, as well as to develop evidence-based guidelines for the management of this condition in children 2, 5.