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The Best Posterior Tibial Tendon Dysfunction Exercises

by Jaydee Vykoukal, PT, DPT April 13, 2022 0 Comments

Exercise in balance pad

When recovering from Posterior Tibial Tendon Dysfunction, exercises are a great tool for rebuilding strength and range of motion. These exercises are recommended by physical therapists, but you should be professionally evaluated prior to starting any new exercise routine. Keep reading for step-by-step guidance and even some video demos.

Posterior Tibial Tendon Dysfunction

The muscles of the legs are important for walking, running and jumping. The posterior tibialis muscle allows you to point your toes down and inward when it is contracted. It also helps keep acts as a stabilizing anchor on the medial (inner) side of the ankle joint. One of its main jobs is stabilizing the arch of your foot so it does not collapse under pressure and become flat with weight bearing activities such as walking and standing.

More About PTTD

Getting Started with 0Exercises

What You’ll Need:

A few basic tools can make the recovery process and your exercise program for PTTD easy and effective. If you don’t have these, don’t fret. You can get creative with what you have around your home as well.

  • Resistance Bands

    This low cost versatile tool is the one option that you should definitely consider a top priority for your exercise program. It will allow you to add resistance to your foot and ankle movements. Each color of resistance band provides a different level of tension that you can gradually progress with.

  • Massage Tools

    There are a variety of options for massaging the lower leg and getting relief from local pain and stiffness. To address knots (trigger points) in the lower leg, consider use of a peanut ball or lacrosse ball. To address larger muscles, like the calves, you can use a foam roller or muscle roller stick.

  • Soft Surfaces

    Once you’ve mastered standing exercises on a solid surface, you will want to try progressing to softer surfaces that further challenge your balance and the stability of your foot and ankle. Options include grass, carpet, or a balance foam pad.

  • Supportive Shoes or Orthotic Inserts

    When you’re exercising, you will most likely be going barefoot to strengthen your feet adequately. However, make sure you keep your foot supported the rest of the day to maximize your results and minimize a flatfoot deformity.

  • Space to Exercise

    You will be sitting on the floor for many of the exercises below so clear a space to stretch out!

  • Timer or Clock

    Make sure you’re holding each stretch for at least 30 seconds. You should be able to complete your entire exercise program in less than 20 minutes so that you can get on with your day while still feeling your best.

    More Ways to Treat PTTD

When & How Often:

The sooner you start an exercise program for your ankle and foot the better. What exercises you start with will depend on the severity and chronicity of your symptoms.

Typically, you will want to start with some gentle daily stretching exercises to promote pain relief and restore some range of motion for better biomechanics. From there, you can then progress to non-weight bearing muscle strengthening of the ankle, foot, and lower leg.

Finally, it’s always important to progress to dynamic weight-bearing exercises to ensure that you can complete your daily activities without re-injuring your foot and ankle. For frequency, try to do your easier exercises daily. As you work toward your harder exercises you can start reducing your frequency to 3 to 4 times per week. 

Stretches & Exercises:

When it comes to an exercise program for PTTD, pain relief and adequate arch control and support is the first priority. This will require some stretching exercises, paying attention to how your foot (particularly the arch) is aligned with activities, and wearing shoes that provide adequate arch support for your feet.  

1. Standing Posterior Tibialis Stretch

The posterior tibialis muscle and tendon become inflamed and dysfunctional with PTTD. Directly stretching these tissues will help restore health, reduce pain, and prep the foot and ankle for a full recovery.

  • Stand near a chair or wall for balance
  • Place your legs in a staggered stance with the ankle you want to stretch in the back
  • Keep your back foot flat on the floor as you shift your weight forward and start to feel a stretch in your calf
  • Stop once you feel a stretch in the calf, then bring your back knee inward toward your opposite thigh while still keeping your foot flat on the ground
  • You should feel a stretch deep in the back of the leg along the shin
  • Hold for 30+ seconds for 2-3 sets on each leg
  • If you have knee problems, refrain from doing this exercise

2. Standing Calf Stretch

Since the posterior tibialis is located in the back (posterior) compartment of the lower leg, it can cause the calf muscles (the gastrocnemius and soleus) to feel tight as well. A deep stretch for this area can provide some relief of tension and discomfort.

  • Stand near a counter, wall, or chair for balance
  • Stagger your legs into a small lunge position with the leg you want to stretch in the back
  • Keep your back foot firmly planted on the ground (don’t let the heel lift)
  • Shift your weight forward as you bend the front knee 
  • Continue shifting until a strong stretch is felt in the calf and hold for 30+ seconds
  • Repeat for 2-3 sets on each leg
  • To reach deeper muscle fibers in the calf, repeat the stretch above but this time keep a slight bend in the knee
  • Hold for another 30+ seconds for 2-3 sets

3. Towel Scrunches

The strength of the small intrinsic muscles within the foot can play a role in providing arch support that is lost with PTTD. Exercises that focus on keeping the arch high and strong will help gradually relieve symptoms as the balance is restored.

  • Grab a hand towel and sit in a chair
  • Place the towel on the ground under the foot you will be working, making sure more of the towel is in front of the toes
  • Lift your toes and stretch them forward toward the edge of the towel while keeping your heel on the ground
  • Place your toes back on the towel and curl them back to bring the edge of the towel closer to you
  • Repeat for 10 to 15 repetitions at a time, readjusting the towel as needed
  • Focus on keeping the arch high during the entire exercise
  • Continue for 2-3 sets

This is just one great option for building foot and toe strength for arch support. You can also try picking up marbles with your toes or “drawing” imaginary letters with your toes. If these exercises are hard to complete with adequate arch control, you can also simply sit with your foot flat on the ground and practice lifting the arch up toward the ceiling. 

4. 3-Way Ankle

This is a great exercise for strengthening the ankle without putting weight through your foot. These are ideal when you are having trouble doing standing exercises because of excessive wobbling and/or pain.

  • Grab a resistance band and sit on the floor in long sitting to get started
  • You will do 15 repetitions of each of the three exercises, then repeat 3 times total 
  • Adjust the level of resistance with the color of band in addition to taking up any slack in the band with your hands
  • First, wrap your band around the ball of your foot/forefoot and hold each end with your hands
  • Point your toes (plantarflexion) as you push into the resistance of the band as far as you can 
  • Return the foot slowly and in control to the starting position and repeat
  • Second, keep the band under the foot and then wrap both ends around the opposite foot and secure both ends of the band in one hand
  • Push the outside edge of your foot away from the midline of your body (eversion) into the resistance of the band
  • Return the foot to the starting position slowly and repeat, making sure to keep the upper leg stable with no knee or hip rotation
  • Third, continue to keep the band around the primary foot but remove it from the opposite foot
  • Now, cross your legs so that the one you are working is on top
  • Place both band ends in the hand that is now diagonal to your ankle (for example- if you’re working the right ankle, it will go in your right hand)
  • Push the inside edge of your foot down and inward (ankle inversion)
  • Return to foot to the starting position with control and repeat

The third exercise directly works the posterior tibialis, so start cautiously and see what you can tolerate. With the help of another person or securing the band below your foot, you can also add a fourth exercise by bringing your toes toward the shin (dorsiflexion). 

5. Calf Raise

Once you’re ready to try some standing exercises, a heel raise is a great place to start. This can be a challenging exercise with PTTD so it’s important to start with a small range of motion that is relatively pain free and feels controlled.

  • Stand near a wall or chair for help with balance with your feet approximately hip width apart
  • Shift your weight into the balls of your feet as you lift the heels up off the ground
  • Lift as high as you can tolerate before slowly returning to the starting position
  • Repeat 15 times for 2-3 sets
  • To progress, hold for 2-3 seconds at the top of each repetition or try single leg raises
  • When you’re ready, you can also try this exercise on the edge of the step to encourage increased range of motion with your reps
  • Never force a range of motion that makes it hard to keep good alignment in your ankle and foot

6. Tibialis Posterior Release

Self-massage of the posterior tibialis muscles and tendon can be very helpful in boosting your healing potential and reducing pain. This is because massage and pressure promote blood flow to the injured area to help it recover. For general massage, you could use a foam roller or massage stick on the calf muscles. We will review a specific release technique, known as trigger point release, for the affected muscle below.

  • Grab a peanut ball or other hard ball (such as a lacrosse ball)
  • Sit on the floor and lean sideways away from the leg you will be addressing
  • Stretch out the leg you will massage with the inside of the leg facing down toward the floor
  • Bend the opposite leg for stability
  • Place the ball on the inside of the lower leg, right behind the shin bone (do not place the ball directly against the bone)
  • Startup high near the knee and hold at each sore spot for 30+ seconds, or until the pain and tension have started to dissipate
  • Gradually move the ball down toward the ankle, stopping at any other sore spots and holding
  • When holding, you can also move the ankle up and down to promote relaxation
  • Continue as long as needed until your symptoms have improved

Tips for Effective Results

To maximize the outcomes of your exercise program, it’s important to keep these tips in mind:

  • Stretch each muscle group for at least 30 seconds to ensure you are getting the best results
  • Do not bounce while stretching, as this can cause injury. Instead, hold the stretch until you feel the tension release
  • Start slowly with your exercise program. If you experience foot or ankle pain with any exercise, modify your range of motion or the overall difficulty
  • Pay close attention to the shape and control of your arch with your strengthening exercises to promote optimal biomechanics and reduce risk of reinjury. Do not let it collapse into a flatfoot or wobble excessively
  • When you’re not exercising, wear supportive shoes or foot orthoses to minimize unnecessary strain of your foot and ankle that can aggravate your PTTD or cause plantar fasciitis as well
  • If you’re unsure of where to start or you’re symptoms don’t improve with this exercise program, consider a round of physical therapy to boost your results and get expert personalized advice
  • Keep your overall health in mind as you recover, making sure to eat a balanced diet, stay hydrated, lose weight (if needed) and properly manage your stress levels

Wrap Up

Posterior tibial tendon dysfunction exercises are designed to help strengthen, stretch and prevent injury to the posterior tibial tendon. A home exercise program is one of the best ways to start down the road to recovery. The most important factor is simply getting started. If you have questions or concerns regarding your symptoms, especially if they become severe, remember to consult a trusted healthcare professional, such as an orthopedic doctor or physical therapist, as soon as possible for further medical advice.

References:

https://hhma.org/healthadvisor/aha-posttibi-rex/

https://recoverathletics.com/the-best-exercises-for-posterior-tibial-tendonitis/

https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=bo1637&

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Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.



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