Tibialis Posterior Tendinopathy

Ms Wang, a young lady executive shuffled slowly into my clinic. "I think I sprained my right ankle on the treadmill 2 days ago", she said. I was expecting a large swollen ankle but it was not that swollen. Then she pointed at the spot on the navicular tubercle (marked 'o' on the picture). She had a previous 'twist' of the same ankle several years earlier.

It sounded like a foot injury seen in my gymnasts, diving and dance sports athletes. She had mild pain when asked to flex and extend her ankle but she could not twist her foot outwards (eversion). She also had pain twisting her foot inwards (inversion) against the resistance of my palm. I palpated (felt with my fingers) the tibialis posterior tendon insertion on the navicular tubercle and she had severe tenderness.

Informed her that her tendon was strained but the deltoid ligament was spared. She needed to ice every 4 hourly (15 minutes/session), avoid high heeled shoes, possibly tape her ankle if she wanted to do more vigorous walking or running, have another look at her walking gait with her shoes, start some isometric exercises and progress to some theraband exercises. "I will see you after a week and expect the injury to heal within 3 to 4 weeks if you do your exercises"