OVERVIEW

What is a Tibialis Posterior Tendon Rupture?

A Tibialis Posterior Tendon Rupture is a tear or complete break of the tibialis posterior tendon caused by severe trauma or tendon degeneration, often accompanied by a medial malleolus fracture.

The Tibialis Posterior Tendon is located on the inner side of the ankle. Its primary functions are foot inversion, supination, and maintaining the medial arch. When ruptured, it can lead to pain, flatfoot, difficulty walking, and an increased risk of arthritis.

SYMPTOMS

What are the symptoms of a posterior tibial tendon rupture?

When the tendon suddenly ruptures during exercise, there is severe pain on the inner side of the ankle, accompanied by a "pop" sound of rupture;

Pain and rapid swelling on the inner side of the ankle, with standing or walking worsening the pain. Bruising appears on the inner ankle after 1 day of injury;

Due to the loss of support from the tibialis posterior muscle on the arch, the arch collapses and flattens, visible from the inner ankle. Flatfoot deformity causes impingement of the lateral ankle structures, and pain may shift to the outer ankle ^[1].

CAUSES

What are the sequelae of posterior tibial tendon rupture?

Joint stiffness is a common sequela, manifested as limited mobility, stiffness, and difficulty squatting. It is mainly related to delayed postoperative rehabilitation or inadequate rehabilitation training. Therefore, patients should follow medical advice, undergo regular healing assessments, and perform timely rehabilitation training ^[2].

How does posterior tibial tendon rupture occur?

• Trauma: A strong impact on the ankle from a fall from height or during sports can cause a medial malleolus fracture, which may further damage the posterior tibial tendon at the fracture site. Alternatively, sharp bone fragments may directly sever the tendon ^[3];
• Tendon degeneration: Physiological aging, inflammatory diseases, or long-term chronic wear can lead to tendon degeneration, resulting in rupture even without significant external force.

Who is more prone to posterior tibial tendon rupture?

• Athletes: Typically those involved in long-distance running or basketball who have suffered severe ankle sprains or direct trauma;
• Middle-aged and elderly individuals: Often women over 40 with multi-joint ligament laxity and occupations requiring prolonged standing.

DIAGNOSIS

Which department should I visit for a posterior tibial tendon rupture?

Orthopedics, sports medicine, rehabilitation medicine in hospitals, or sports medicine clinics and sports rehabilitation centers.

How to self-diagnose a posterior tibial tendon rupture?

You can make a preliminary judgment based on the following symptoms. If symptoms persist, seek professional medical evaluation from a doctor or rehabilitation specialist:

• Immediate pain and swelling on the inner side of the ankle after injury, difficulty bearing weight or walking, and inability to exert force inward with the toes;
• Noticeable tenderness along the posterior tibial tendon (below and behind the prominent bone on the inner ankle);
• Visible collapse or flattening of the foot arch from the inner ankle;
• Inability to walk independently for at least 4 steps immediately after injury or during examination, with tenderness along the posterior edge of the distal tibia (within 6 cm) or the inner ankle—suspected fracture requiring prompt medical attention.

Is imaging necessary for a posterior tibial tendon rupture?

Yes.

X-rays can detect associated ankle fractures or dislocations; ultrasound or MRI can identify structural changes such as longitudinal tears, avulsions, or ruptures of the tendon, providing definitive diagnosis.

TREATMENT

Can a posterior tibial tendon rupture heal on its own?

No.

A posterior tibial tendon rupture is often accompanied by an ankle fracture. Without treatment, it can eventually lead to pain, deformity, flatfoot, and loss of walking, running, and jumping functions.

What should be done immediately after a posterior tibial tendon rupture injury?

The immediate treatment goals are to reduce bleeding and swelling, relieve pain, and prevent further injury. Measures include:

1. Stop activity after the injury, avoid weight-bearing on the affected limb to prevent worsening the injury.
2. Apply ice compression to the painful area immediately to reduce pain and inflammation. Continue icing for 2–3 days post-injury as needed. Place an ice pack (plastic bag with ice water) on the affected area with a thin cloth between the ice and skin to prevent frostbite. Ice for 15–20 minutes every 2 hours, 4–5 times daily.
3. Wrap the affected area with an elastic bandage to reduce bleeding; remove after 24 hours. Avoid wrapping too tightly to prevent circulation issues. If toes become painful or swollen, remove and rewrap.
4. Elevate the affected leg above heart level with 1–2 pillows when sitting or lying down to promote blood flow.
5. For severe pain, use NSAIDs (e.g., ibuprofen, naproxen) under medical guidance.

How is a posterior tibial tendon rupture treated?

Complete ruptures require surgical repair followed by immobilization and rehabilitation to restore normal ankle function.

Conservative treatment is limited to partial or longitudinal tears or patients prohibited from surgery due to age or severe systemic conditions.

How to rehabilitate after posterior tibial tendon rupture surgery?

Post-surgery, the ankle must be immobilized for healing, with duration varying by injury severity and recovery progress.

Typically, the foot is immobilized in a cast or walking boot for 4–6 weeks without weight-bearing, using crutches. Severe cases may require a wheelchair.
Keep other body parts active. After cast removal, begin active rehabilitation to restore mobility and strength, regaining basic functions like walking and stair climbing. Most patients can resume sports after 6 months ^[5].

How long does it take to recover from a posterior tibial tendon rupture?

Recovery time varies. With timely rehab, basic functions (walking, stairs, driving, squatting) typically return in 2–3 months; sports can resume by 6 months ^[4].

How to walk correctly with crutches after surgery?

Axillary crutches aid mobility during recovery. Progress gradually:
Non-weight-bearing (two crutches) → partial weight-bearing (two crutches) → partial weight-bearing (one crutch) → independent walking. Proper use prevents gait abnormalities and secondary injuries.

Walking training phases:

1. Non-weight-bearing with two crutches
2. Partial weight-bearing with two crutches
3. Partial weight-bearing with one crutch

What rehab exercises can be done early after surgery?

Weeks 1–4 focus on immobilization and non-weight-bearing to allow healing. However, other body parts should stay active to aid overall recovery.
Athletes should maintain cardio with upper-body ergometers and train unaffected limbs for faster return to sports.

Safe exercises for the affected leg (adjust as needed; stop if discomfort occurs):

1. Supine straight leg raise
2. Side-lying hip abduction
3. Side-lying hip adduction
4. Prone leg lift

What rehab exercises can be done mid-recovery after surgery?

Weeks 5–8 introduce weight-bearing and crutch walking, progressing from two crutches to one, then independence. Begin active ankle flexion/extension mobility and strength training; add inversion/eversion at 6 weeks. Continue early-phase exercises. Stop if discomfort occurs.

1. Ankle flexion/extension mobility
2. Ankle inversion/eversion mobility
3. Weight-bearing standing
4. Dorsiflexion strength
5. Plantarflexion strength
6. Eversion strength
7. Inversion strength
8. Foot intrinsic muscle training
9. Hamstring stretch
10. Seated calf stretch

What rehab exercises can be done late in recovery after surgery?

Beyond week 9, focus on weight-bearing strength and balance training for the ankle, thigh, and hip muscles, improving proprioception. Add these exercises (stop if discomfort occurs):

1. Dynamic ankle mobilization
2. Plantarflexion strength
3. Single-leg stance
4. Squats
5. Lunges
6. Monster walks

DIET & LIFESTYLE

Can patients with posterior tibial tendon rupture apply heat therapy?

It depends.

Do not apply heat therapy (including hot baths, heat packs, heat lamps, thermomagnetic therapy, etc.) within the first 3 days after injury or within 1 week after surgery. Avoid using heat-generating plasters to prevent inflammation from spreading, swelling from increasing, and delaying healing.
After the cast is removed, heat therapy can be used to improve blood circulation and promote metabolism, such as foot soaks or electric heating pads. Patients with access to rehabilitation facilities or sports rehabilitation centers can undergo physiotherapy, such as heat lamps or thermomagnetic therapy.

How should patients with posterior tibial tendon rupture adjust axillary crutches?

Before using axillary crutches, adjust them according to the patient's height. Improper height adjustment or incorrect usage may compress the nerves in the armpit, causing damage.

With the patient standing upright and arms relaxed at the sides, elbows bent at 20°–25°, adjust the height of the armpit rest and handle of the crutches. The adjustment methods are as follows:

• Armpit rest: Place the tip of the crutch 15 cm in front and 15 cm to the side of the foot, leaving 2–3 finger widths (about 5 cm) of space between the armpit rest and the armpit.
• Handle: Adjust the height to align with the radial styloid process (approximately at the wrist).

PREVENTION

What are the preventive measures for posterior tibial tendon rupture?

1. Avoid exercising on uneven roads and jumping from heights to prevent tendon rupture and fractures caused by strong impact;
2. Patients with flat feet should wear sports shoes with medial arch support or use arch-supporting insoles to reduce tendon wear and degeneration;
3. Use protective taping or wear ankle braces during exercise, as braces can effectively reduce the risk of ankle sprains, especially for patients with a history of sprains;
4. Athletes should strengthen ankle stability to prevent ankle sprains. Those with recurrent sprains and swelling require systematic rehabilitation training.
5. The following lists stability exercises that can be performed at home. Unstable surfaces can be created using household pillows or cushions, or specialized rehabilitation equipment like balance pads or BOSU balls.

Recommended exercises include:

• Single-leg standing
• Single-leg standing on an unstable surface
• Single-leg standing with eyes closed

Warm up thoroughly before exercise. In addition to traditional cardio exercises like running or cycling, include dynamic stretching, muscle activation, and sport-specific movement preparation. Here are some warm-up activities to enhance ankle stability:

• Toe walking
• Heel walking
• Lateral foot walking
• Swallow balance (single-leg stance with torso forward)