Inside of the Ankle Pain [Posterior Tibial Tendonitis Treatment] 2021

19December 2021

– Inner arch pain is
posterior tibial tendonitis. Nobody knows what this muscle is, but almost everybody
that comes into clinic with inside of the ankle pain has posterior tibial tendonitis going on. I'm going to show you the
four stages of flatfoot and why this is important, why you should care, and why
I'm so excited about this. And we're starting right now. If you've ever had flat foot,
inside of the ankle pain, so right through here, numbness burning, tingling, radiating. If you ever had to adjust your
feet while you're standing, 'cause your ankles getting sore. If you ever got fatigued while walking, very likely, this is
posterior tibial tendonitis, your foot flattening out, leading to plantar fasciitis,
and then ankle pain. So if you have flat foot, your posterior tibial
tendon is being overworked and very sore and it starts
throbbing during the day. This is what causes shin
splints, tired arches, your foot buckling out
and unable to support you, and then leads to inner knee pain.

It then leads to hip pain. So causes are, if you're too
tight through your calf muscle, through your hamstring, if you're adjusting for a bad back, hamstrings knees, these are all things that overwork your posterior tibial tendon. This leads to four stages of flatfoot. So at stage one of the
Johnson Strom classification is when your posterior
tibial tendon is sore, but there's no deformity yet. This is younger people
that are overworked. People have to work 12
hour shifts, athletes, runners who get shin splints,
who start getting sore. And a stage one is important
because it's very treatable. This is when things like
stretching, massaging, all this stuff helps. Stage one is you're just sore. There's no real changes to your foot. So you can see right here, I still have my arch, that's stage one. Stage two would be if
your arch is collapsing. So you could see right here, so stage one is just
soreness through here, but you still have your arch. When it collapses, that's stage two. So it's still flexible, because flexible means I can turn it in.

Stage two. So come back at the end, because the end is going to
be the most important part. Stage two is when your tendon starts to get so sore that your
foot starts to flatten out. So you start to curve and flatten out. That's stage two. Still correctable, because you don't have
permanent arthritis, you don't have permanent damage, but you're having a hard time getting through your work shift. You're having a hard time
making it through your run. You're having a hard time playing sports. You're getting pretty
painful shin splints. Here's our specific shin splint guide, but this is all the same, so
just keep watching this video. What happens is your foot
starting to buckle out, so you can still treat it, So stick around to the
end because our treatments are going to be really important for you. Because eventually you get to stage three. This is when the tendon
starts to get so sore. It's like Laffy Taffy, it starts to tear.

You get posterior tibial
tendonosis at this point. This means degeneration and atrophy of the posterior tibial tendon. So specifically when you look at the foot and the foot presses down, you can see the foot starts to deform. It eventually gets stuck
in this flat foot phase where no matter what you do,
you can't straighten it out. So see how it's straight right here? With arthritis, it flattens out, and you can see as I'm pushing down, it's stuck in this flat foot position. So these bones eventually
lose their cartilage and can't move very well. So squish, arthritis, squish, arthritis. Stage two, you can
reduce it back to normal. Stage three, it's stuck in this position. So looking from the back,
this is stage three.

And stage three, you really got to start
taking this seriously, 'cause you can still get it better. You can't fix the arthritis,
because stage four, stage three is when it's down, and when the doctor tries to turn you in and you can't unflatten arch. So flexible is if you can
turn in and recreate the arch. So you could see if I can
fit that underneath there.

That's still an arch. Right there, I can't fit anything under. So stage three is if you can't reduce that arch back into place. So this doesn't seem like
it's you if you're young, but if you're old, like
sixties, seventies, you can't recreate that arch,
so that's a stage three. Your ankle actually
buckles and dislocates. So see what's going on back here, that's stage four. Your ankle actually starts dislocating. So specifically this area right here, the bone starts to crush into the back, causing subtalar joint
arthritis, ankle arthritis. At this point in a stage four, your posterior tibial tendon
is completely destroyed.

So this is stage one. This is stage two. Stage three is when I can't rotate it in. But two, if I could rotate it
back in, that means it's two. Whereas stage four is a
complete buckle of the ankle. So that, that means I can't even show it, but the whole ankle's
buckling out at that point. So diagnosis, you got
to see your podiatrist if this is happening to you. In a stage one and two, all
we need to do as an X Ray, we got to make sure nothing's broken. We have to make sure you
don't have a heel spur or Achilles tendon insertional
arthritis, or a spur there. All these things are related,
as your foot flattens out, but stage one and two, it's correctable. But as you get into stage three on x-ray, we're going to take an X Ray, and we're going to see arthritis. If you get an MRI, you're going to see that
this posterior tibial tendon is starting to rupture and tear already.

So if that tears, you
need to be in a brace, you need to be in a good orthotic. The treatment guide's very important. If you're in a stage one or two, it's very important to
start cross training. So if you're an athlete and
you're a long distance runner, start riding the bike, riding the bike is great cross training. Your feet gradually will
start to feel better. Number two, you want to
get the inflammation down. So icing, using good orthotics,
good shoes, good braces. All that will let your muscle relax. That doesn't mean you can just
keep working more and more. You still gotta relax a little bit too. And kind of like taking an elastic from a freezer onto the counter.

Gradually it starts to get
more flexible on its own. And that's when you can start stretching, when the inflammation is gone. So as you protect it, nurture it, let it start feeling good, and
you can start stretching it. So this is where something
like a night splint comes in, doing calf stretches, hamstring stretches. All this stuff really starts
to benefit you at this point. Now we get into the really corrective. So number one, this is a must, you 100% have to get a good shoe.

So a good shoe means a stiff heel, see how I can't bend this down. Right here, stiff mid-sole
so you can't bend it, and a flexible front. If you're a great athlete, if you could run like a 5K
and you're in great shape, look at our minimalist shoe guide. That can really help. But for everybody else, realistically, a good supportive shoe is where it's at. And with a good shoe, you
have to get an orthotic. So you don't have to get an expensive one. Everybody already thinks custom inserts. But look at this right here, you can get a $20, $30
over the counter orthotic. That's gonna support your arch. So see the arch can't collapse in there.

This posterior tibial tendon,
I'm going to estimate, only has to do about 50% of the work. That will correct your
flat foot pretty quickly. So this orthotic right here, what it does is it supports my foot, so I can't roll out. So right here, for example, I have an easy time without the orthotics, I have an easy time
rolling my foot in and out. With the over-the-counter
orthotic, it keeps me more stable. So I can't really rock it. Like I got to really work hard, but I'm pretty stable there. Whereas with the custom orthotic, now that really holds me. I can barely move at all.

So what happens is I
can feel it stretching. See my Achilles tendon right here. This one has a little bit of a lift. So you can see this one has about a two millimeter lift right here. So my foot doesn't need to turn out. And when I walk, my foot is flat. So it keeps me in that stage one plane without this irritation. So when I step right here, you could see I'm flattening. With this one as I step, I can
still flatten a little bit. Whereas with this one,
I can't flatten at all. So I'm trying, and this muscle does not
have to work very hard, because normally this twists me in, but now the orthotic is
holding me twisted in. So this muscle barely has to work at all. So it takes a little while to relax, but it will gradually relax. That will stop pronation. And if your foot's not really pronating, your posterior tibial tendon
is not working as hard.

So a good shoe, a good orthotic. I would estimate my
unscientific opinion here, at least 50% relief. So standing for eight hours feels more like standing for four hours without the orthotic or the shoe. If the over the counter is not working, you want to upgrade to a custom insert. So not everybody needs this, but if you're really working heavy hours and you're suffering in pain, if you're really
overweight and inflexible, you might need this to not lose your job and to make it through. So this can work really
well in the meantime. So if the shoe, the orthotic,
the inflammation control, the stretching, didn't do it. You should get yourself an ankle brace. So kind of stage one ankle brace. So for a grade one and two, you can get a compression ankle brace, a compression ankle brace
is much more comfortable.

I find more people actually wear them than a stability, brace. A stability brace is great. I love stability braces
if you're really injured. But a stability brace, this
is now a stage two, three, a stability brace, it's
a lot of work to put on. You've got to lace it up, you've got to get it into your shoe. But as you get it into your shoe, and now it's laced up,
you're doing really well. And then for the higher stages, if you partially tore or damaged it, so this is your podiatrist like myself, got an MRI or an ultrasound, and you're starting to
get some PT tendon injury, you need to wear a boot.

And then potentially
if you're so flatfooted and you're so arthritic,
surgery is an option. So there are flat foot surgeries and we won't go over them in this video. And with the stretching, you can work with your podiatrist to diagnose where you're tight your hamstring, your hip,
your knee, your calf muscle. You can work with your podiatrist
and physical therapist. You can then get great orthotics. You can then get a great brace. You can then potentially
use a boot or get surgery. I'll tell you what though. Sub 5% by far, sub 5% ever need surgery. This is crippling painful
situations, it's very rare..

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