MLB: Tampa Bay Rays at Chicago White Sox

Chicago White Sox rookie, Jose Abreu, had an MRI to determine if there were any damages to his left ankle. The MRI revealed “inflammation only” according to sources. His official diagnosis is “Posterior Tibial Tendonitis.” Abreu has been placed on 15-day DL.untitled

Posterior tibial tendonitis is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in a flatfoot.

The posterior tibial tendon is one of the most important tendons of the leg. A tendon attaches muscles to bones, and the posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot. The main function of the tendon is to hold up the arch and support the foot when walking. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time.

Symptoms include:

  • Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area.
  • Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time.
  • Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot.

Test for this injury include:A00166F03

Too many toes” sign. When looking at the heel from the back, normally only the fifth toe and half of the fourth toe are seen. In a flatfoot deformity, such as one that can occur with this injury, more of the little toe can be seen.

“Single limb heel rise” test. Being able to stand on one leg and rise up on “tiptoes” requires a healthy posterior tibial tendon. When a patient cannot stand on one leg and raise the heel, it suggests a problem with the posterior tibial tendon.A00166F04

Treatment for posterior tibial tendonitis is typically non-surgical, and includes, but is not limited, the following:

  • Decreasing or even stopping activities that worsen the pain as soon as possible. Switching to low-impact exercise is helpful. Biking, elliptical machines, or swimming do not put a large impact load on the foot, and are generally tolerated by most patients.
  • Apply cold packs on the most painful area of the posterior tibial tendon for 20 minutes at a time, 3 or 4 times a day to keep down swelling.  Placing ice over the tendon immediately after completing an exercise helps to decrease the inflammation around the tendon.
  • Drugs, such as ibuprofen or naproxen, reduce pain and inflammation.
  • A short leg cast or walking boot may be used for 6 to 8 weeks. This allows the tendon to rest and the swelling to go down.
  • Most people can be helped with orthotics and braces. An orthotic is a shoe insert. It is the most common nonsurgical treatment for a flatfoot. An over-the-counter orthotic may be enough for patients with a mild change in the shape of the foot. A custom orthotic is required in patients who have moderate to severe changes in the shape of the foot.
  • A lace-up ankle brace may help mild to moderate flatfoot. The brace would support the joints of the back of the foot and take tension off of the tendon.
  • Physical therapy that strengthens the tendon can help patients with mild to moderate disease of the posterior tibial tendon.
  • Cortisone is a very powerful anti-inflammatory medicine that your doctor may consider injecting around the tendon. A cortisone injection into the posterior tibial tendon is not normally done. It carries a risk of tendon rupture.

Provided by the Primus Sports Medicine Staff