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Stop Posterior Tibial Tendonitis Pain Naturally: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment

What is posterior tibial tendonitis? 

Posterior tibial tendon dysfunction is an acquired disease of the ankle and foot that commonly affects middle-aged individuals. The tendon failure gives rise to the involvement of the surrounding ligamentous structures along with the deformity of the bony structures. The prevalence of posterior tibial tendonitis is 3.3-10%, based on the age and gender of the patient. In this pathology, the posterior tibial tendon is subjected to microtrauma and resultant tendonitis with increased neovascularization, fibroblast hypercellularity, and mucin contentment. [1] This article describes the symptoms, causes, and risk factors of posterior tibial tendonitis pain as well as elaborates normal healing cycle and treatments for alleviation of posterior tibial tendonitis pain.

Causes and Risk Factors of Posterior Tibial Tendonitis 

The causes and risk factors of posterior tibial tendonitis are enlisted as follows. [1]

  1. Bad shoes
  2. Gait abnormalities 
  3. Ankle sprain
  4. Pronated foot
  5. 부상
  6. Female gender
  7. Age over 40 years 
  8. 비만 
  9. 당뇨병 
  10. Hypertension 
  11. Previous trauma history
  12. Steroid exposure 

Symptoms of Posterior Tibial Tendonitis 

The symptoms of posterior tibial tendonitis are enlisted as follows. [1]

  1. Pain in the inside of the foot
  2. Ankle pain
  3. Ankle swelling 
  4. Increase in pain with high impact 

Normal Wound Healing Cycle and Chronic Conditions 

The normal healing cycle is based on four stages including hemostasis, inflammation, proliferation, and maturation. The description of each stage of the wound healing cycle is given in the table below. In the case of chronic conditions, the wound healing cycle moves back and forth between the two stages – inflammation and proliferation stages. The persistence of both these stages in chronic conditions prevents the healing cycle to reach the resolution stage. In order to normalize the healing cycle, it is important to adopt measures that target the resolution of the inflammation and proliferation stages of the healing cycle. [2, 3]

Stages of the wound healing cycle

설명

Hemostasis stage The first stage is known as hemostasis. The characteristic mechanisms of this phase of the healing cycle include vasoconstriction of the blood vessels, and changes in the platelets including aggregation, degranulation, and blood clot formation. This phase mainly contributes to limiting blood loss by making a blood clot or a thrombus. 
염증 단계 The second stage of the healing cycle is the inflammation stage, which is a response to injurious stimuli. It is characterized by the recruitment of inflammatory and immune cells at the site of injury, which ultimately releases different cytokines and inflammatory mediators. The cardinal signs of inflammation include loss of function, warmth, redness, pain, and swelling.
Proliferation stage The third stage of the healing cycle is known as the proliferation phase. During this phase, new blood vessels form at the site of injury by a process called angiogenesis, the extracellular matrix is synthesized, re-epithelization occurs, and collagen is produced at the injured site. 
Maturation stage The fourth and last stage of the healing cycle is the maturation stage, which marks the resolution of the healing cycle. During this stage, the blood vessels undergo maturation and degeneration, and wound contraction, scar formation, and deposition of collagen type I take place.

 

Ineffective Treatment Measures for Posterior Tibial Tendonitis 

Individuals usually choose different traditional therapeutic strategies for relieving posterior tibial tendonitis pain. These therapeutic measures are common yet ineffective for relieving pain. 

  1. Application of heat and ice
  2. Electrical stimulation of the site of pain or injury
  3. Use of foam roller and massaging on the site of pain or injury
  4. Stretching of the site of pain
  5. Mobilization of the site of pain 
  6. Strength exercises during the inflammatory stage of the wound healing cycle 

Effective Treatment Measures for Posterior Tibial Tendonitis 

The following tables comprise the characteristics of the aberrant wound healing cycle along with effective treatment measures that resolve the inflammation and proliferation stages, in order to reach the maturation stage and provide pain relief in posterior tibial tendonitis. 

Stages of the wound healing cycle Chronic conditions in wound healing Effective treatment measures
염증 단계 Chronic disease conditions such as chronic pain in posterior tibial tendonitis are characterized by increased pro-inflammatory mediators and oxidative stress at the site of injury. 
  • One shall ensure adequate rest of the affected foot to promote recovery from posterior tibial tendonitis pain.
  • One shall use the MagnaHeal device to promote the resolution of the inflammation stage of the healing cycle.
  • One shall consume an anti-inflammatory diet along with the intake of anti-inflammatory supplements. 
  • AskASTR program is useful for aiding individuals in identifying nutritional deficiencies and the correct supplements.  
Proliferation stage Chronic disease conditions such as chronic pain in posterior tibial tendonitis are characterized by the formation of scar tissue, fascia restrictions, and muscle trigger points or muscle knots in the injured area. 
  • The ASTR A1 Tool is used for releasing the fascia restrictions in the upper two fascia layers, which are the superficial fascia and aponeurotic fascia.
  • The ASTR A3 Tool is used for releasing the superficial muscle knots or the muscle trigger points and superficial scar tissue.
  • The ASTR A5 Tool is used for releasing muscle trigger points, scar tissue, as well as fascia restrictions in the endomysium, epimysium, and perimysium. It also releases the deep muscle trigger points and deep scar tissue.

 

Other therapeutic measures
  • One shall practice walking with a normal gait
  • One shall wear good shoes 
  • One shall ensure correct pronation foot 

 

결론 

Posterior tibial tendonitis pain is associated with ankle pain and foot pain, particularly among middle-aged adults. This not only hinders the functioning of an individual but also influences the optimal performance of daily activities. While conventional approaches may provide short-term pain relief, these are not effective in resolving the inflammation and proliferation stages of the wound healing cycle. ASTR-based tools and protocols including anti-inflammatory supplements, MagnaHeal device, and A1, A3, and A5 tools are useful in resolving the inflammation and proliferation stages of the healing cycle and alleviating posterior tibial tendonitis pain. In addition to this, these treatment approaches are not associated with any side effects of complications.

참고문헌

  1. Knapp PW, Constant D. Posterior Tibial Tendon Dysfunction. [Updated 2022 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542160/
  2. Guo, S., & Dipietro, L. A. (2010). Factors affecting wound healing. Journal of dental research89(3), 219–229. https://doi.org/10.1177/0022034509359125
  3. Wilkinson, H. N., & Hardman, M. J. (2020). Wound healing: cellular mechanisms and pathological outcomes. Open biology10(9), 200223. https://doi.org/10.1098/rsob.200223