Thermography and Recovery from Posterior Tibial Tendinopathy: The Case of Gaël Le Bellec

In elite sports, injury prevention and monitoring are crucial to prolong athletic careers and optimize performance. This article presents a practical case illustrating the use of infrared thermography (IRT) and functional assessment in the rehabilitation of posterior tibial tendinopathy in the right foot of world-class duathlete Gaël Le Bellec, three-time world champion.

Clinical Context

The athlete, retired from professional circuits but still active in high-level competition, began experiencing medial ankle pain in late 2023. Despite a reduction in training volume and corticosteroid intervention, symptoms persisted for several months, eventually leading to a stress fracture of the posterior tibial tendon as confirmed by magnetic resonance imaging (MRI).

Timeline:

• December 2023: Onset of medial ankle pain (right foot).
• January 2024: MRI reveals inflammation of the posterior tibial tendon.
• February 2024: Corticosteroid injection administered; return to training.
• March 2024: Pain relapse; new MRI confirms a stress fracture; complete training cessation.
• July 2024: Functional and thermographic assessment performed prior to reintroducing physical load.

Functional and Thermographic Assessment

Infrared Thermography (July 11, 2024)

Thermal images revealed:

• Temperature asymmetry > 0.6°C between both feet, with higher temperatures in the medial plantar region of the right foot.
• Localized inflammation in the posterior tibial tendon area.
• Hotspot in the plantar arch, corresponding with the symptomatic region.

These findings indicated persistent local irritation consistent with an ongoing inflammatory process.

Functional Assessment

A structured evaluation of foot stability, strength, and structure identified:

• Significant instability, particularly during single-leg stance on the right foot.
• Marked weakness in both intrinsic and extrinsic muscles of the affected foot.
• Underdeveloped plantar arch, indicating poor support mechanics.
• Generalized strength deficit throughout the foot and ankle complex.

Progressive Return to Training

By the end of July 2024, after over three months of rest, the athlete resumed training with a gradual progression. This return was guided by a structured rehabilitation plan focusing on muscular reinforcement, plantar support control, and thermal monitoring of the injured area.

Key Conclusions and Takeaways

This case demonstrates how integrating infrared thermography into clinical and sports practice can:

• Objectively detect active inflammation in a non-invasive manner.
• Track relevant thermal asymmetries to inform return-to-play decisions.
• Guide targeted rehabilitation strategies, especially muscle strengthening of the foot and ankle.

Key recommendations:

• Specific rehabilitation of the posterior and anterior tibial muscles.
• Strength training using external loads for foot musculature.
• Athlete education and a long-term maintenance program to prevent recurrence.
• Periodic reassessment using thermal imaging and functional tests.