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Medial and Lateral Ankle Pain

Posterior Tibial Tendonitis and Tears

The posterior tibial tendon attaches the muscle to the bones on the inside of the foot, helping to hold up the arch and providing support when walking. The tendon can become inflamed from overuse (tendinitis) and can develop tears as a result of an acute injury. If left untreated the tendon can stretch out and degenerate and the arch of the foot will collapse and can cause a flat foot. Symptoms of posterior tibial injuries include pain along the inside of the foot and ankle that may worsen with activities, swelling, and pain on the outside of the ankle as a result of the foot collapse and flattening. Diagnosis involves a physical examination and sometimes an X-ray, MRI, or CT scan and treatment begins with rest, ice, anti-inflammatory medications, immobilization, orthotics, braces, and physical therapy if there is tendinitis and no collapse the arch. If symptoms persist, surgery may necessary to remove the inflammation.

Tears in the posterior tibial tendon require surgical repair. Longitudinal tears without any flattening of the foot require direct repair along with removal of inflamed tissue. Once the foot flattens and the arch collapses surgery is necessary to correct the deformity. If the foot remains flexible, tendon transfer with bone osteotomies and realignment is needed. If the deformity is rigid fusion of the joints are performed.

Peroneal Tendonitis and Tears

The Peroneal tendons run along the outside of the ankle and like the posterior tibial tendon, are prone to overuse injuries. Injuries may also occur with ankle sprains. Symptoms of tendinitis and tears include pain around the back and side of the ankle and foot. Swelling may occur. Diagnosis includes an exam and often X-rays, MRIs, or CT scans. Conservative treatment can be used with peroneal tendinitis and includes rest, ice, anti-inflammatory medications, orthotics, braces, immobilization, and physical therapy. Surgery can be an option if symptoms are not relieved with conservative treatment. Tears of the peroneal tendons may occur with tendinitis. In addition the tendons may sublux or over the fibula instead of remaining in their groove behind the fibula. Surgery is hard to repair torn or subluxing peroneal tendons.