Ankle Pain – Physiotherapy Can Help


Common ankle injuries are caused by a sudden traumatic event where someone might ‘go over’ on their ankle, also known as an ankle sprain. This usually occurs on the outside (lateral side) of the ankle. Ankle sprains are less common on the inside (medial side) of the ankle as the ligaments on this side are stronger. However, medial ankle pain is very common and usually occurs gradually over time. This pain can often be identified as posterior tibialis tendon dysfunction (PTTD). PTTD refers to the loss of strength in the tibialis posterior tendon which can be sudden or progressive. This weakness leads to an unopposed pull of the muscle working on the opposite side of the leg and the secondary effect of a progressive flatfoot deformity.

So what does this mean?

The tibialis posterior is a muscle located deep in the centre of the back of the leg. The tendon of this muscle travels down the back of the leg, behind the medial malleolus (bony prominence on the inside of the ankle) and separates where it attaches onto the underside of the bones of the foot. It is the key stabilising muscle of the lower leg and it assists the normal functioning of the foot during gait. PTTD can be caused by degeneration and by traumatic event. Dysfunction of this muscle can lead to lack of support of the medial arch of the foot which can lead to flat feet in adults and foot deformity. Patients suffering from PTTD will typically complain of medial ankle pain, swelling and a flattening of the arch of the foot.

What can I do to help?

● Wear supportive shoes
● Avoid wearing ballet pumps, slippers or going barefoot
● Avoid excessive weight-bearing activities
● Descend stairs with the painful foot first
● Use orthotics from your physiotherapist or trained health professional

How can physiotherapy help?

● A Chartered Physiotherapist will take a detailed subjective assessment to learn more about your pain and condition
● They will assess the foot for swelling, deformity, pain, dysfunction and weakness
● Based on their findings, they will determine what course of action is best
● Stage 1 & 2 PTTD can benefit from physiotherapy conservative management
● Stage 3 & 4 PTTD need to be referred for an orthopaedic review

Stage 1 & 2 PTTD physiotherapy treatment includes the following:

● Soft tissue release of the tibialis posterior to restore the proper blood supply to the muscle and reduce fibrotic tissue/adhesions
● Stretching the calf muscles to improve range of motion and reduce foot deformity
● Strengthening the tibialis posterior to restore muscle function
● Offload the tendon through the use of an orthotic

Take home message

● PTTD is a common cause of medial ankle pain
● Timely diagnosis is essential as physiotherapy is the recommended treatment in the early stages
● Effective prompt management can reduce the likelihood of long term pain and deformity
● If you suffer from medial ankle pain, please contact us today to see how we can help
● Early physiotherapy management can help to eliminate pain and restore normal function