Pre-stage 1 Posterior Tibial Dysfunction/Tibialis Posterior Myofascial Tightness (TPMT):
May be a myofascial trigger point that precedes the development of posterior tibial dysfunction – no inflammation of tendon.
Patient complains of pain on weightbearing first thing in the morning of insidious onset. Increased activity increases symptoms – may be described as ‘stone under the heel’ – or pain on using car brake. Pain is assumed to be referred to the heel from the myofascial unit distal to the heel. Heel raise test may show lack of calcaneal inversion and arch height increase on involved side – this may reproduce symptoms. May have limited propulsion during gait. Posterior tibial length test may reproduce symptoms. Manual muscle testing usually within normal limits. Palpation of plantar heel not usually symptomatic (heel spur syndrome/plantar fasciitis are generally painful to palpation).
Management – manual stretching of posterior tibial muscle – maintain posterior tibial length test/Patla posterior tibial test for 2 minutes to stretch muscle – do 4 times. Foot orthoses if biomechanical faults identified.