Inflammations and tears of the tibialis posterior tendon are often classified into the following stages:

1. Stage I (Tendinitis): Inflammation without structural damage, often accompanied by pain and swelling.
2. Stage II: Partial tendon damage with the onset of foot deformity (flexible flatfoot).
3. Stage III: Progressive tendon damage with rigid flatfoot and limited mobility.
4. Stage IV: Severe foot deformity involving the ankle joint and possible permanent damage.

The main causes of inflammation or rupture of the tibialis posterior tendon can be divided into several categories:

- Overuse:

- Repeated stresses, especially in sports such as running, jumping, or hiking, can lead to microtrauma.

- Degenerative changes:

- As age increases, the elasticity of the tendon decreases, making it more susceptible to tears.

- Chronic micro-injuries can accelerate wear and tear.

- Foot deformities:

- Flat feet or other deformities increase the pressure on the tendon and promote its damage.

- Traumatic events:

- Sudden injuries, for example from twisting or direct blows, can lead to an acute tear.

- Accompanying diseases:

- Diseases such as rheumatoid arthritis or diabetes mellitus increase the risk of tendon damage.

The symptoms vary depending on the severity and stage of the disease and include:

- **Pain:** Localized pain along the inner ankle, often exacerbated by activities such as walking or standing.

- **Swelling:** Visible swelling in the area of the tendon, sometimes accompanied by redness and warmth.

- **Movement restrictions:** Difficulty turning the foot inward or standing on tiptoes.

- **Weakness:** Noticeable weakness during foot movements, especially when rolling off.

- **Foot deformity:** Development of a flatfoot with loss of the normal arch.

- **Instability:** Feeling of insecurity when walking, especially on uneven terrain.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

• Medical history: The doctor inquires about the patient's medical history, existing complaints, and possible triggering factors such as injuries or overuse.
• Physical examination:
  • Visual inspection and palpation of the tendon for tenderness or swelling.
  • Functional examination of the foot, including tests for stability and mobility.
• Imaging techniques:
  • Ultrasound: Visualization of the tendon and identification of inflammation or tears.
  • MRI: Detailed examination of soft tissues to assess the extent of damage.
  • X-ray: Exclusion of bony misalignments or degenerative changes.

Conservative Therapy

In most cases, inflammation or a partial tear can be treated conservatively:

• Immobilization:
  • Immobilization of the foot using orthoses or special shoes to relieve the tendon.
• Physiotherapy:
  • Exercises to restore mobility and strengthen the surrounding muscles.
  • Proprioception training to improve stability.
• Pain medication:
  • Taking anti-inflammatory medications such as ibuprofen or diclofenac.
• Orthopedic aids:
  • Use of shoe inserts or special insoles to support the arch of the foot.

Surgical Therapy

In cases of complete tears or advanced tendon damage, surgery may be necessary:

• Tendon reconstruction: Restoration of the torn tendon by suturing or reinforcement with the body's own tissue.
• Tendon transfer: Transfer of an adjacent tendon to restore function.
• Ankle joint fusion: In severe cases, to stabilize and prevent further deformities. 

To prevent tendon damage, the following measures are recommended:

1. Regular exercise: Strengthening of the foot and lower leg muscles through targeted exercises.
2. Ergonomic shoes: Wearing suitable footwear with adequate cushioning and support.
3. Avoiding overstrain: Gradually increasing the load during sports activities.
4. Early treatment: At the first signs of pain or instability, a medical examination should be carried out.
5. Weight control: Reducing excess weight to relieve tendons and joints.