Posterior tibial tendonitis is a condition characterized by inflammation and damage to the posterior tibialis tendon, which is crucial for activities such as standing on the toes, pushing off during running or jumping, and turning the foot inward (inversion). Here is a comprehensive guide to the exercises and treatments that can help manage and recover from this condition.
Understanding the Condition
Before diving into the exercises, it’s important to understand the signs and symptoms of posterior tibial tendonitis. Common symptoms include pain, tenderness, or swelling over the back and inside part of the ankle, pain when standing on the ball of the foot or during ankle motion, and a cracking sound when the tendon is moved or touched[2].
Initial Treatment and Preparation
Rest and Activity Modification
The first step in treating posterior tibial tendonitis is to decrease or stop activities that worsen the pain. Switching to low-impact exercises like biking, elliptical machines, or swimming can be helpful. Weight loss can also reduce stress on the arch and its supporting structures[5].
Use of Ice and Heat
Apply cold packs to the most painful area for 20 minutes, 3 or 4 times a day, to reduce swelling. Heat can be used before performing stretching and strengthening exercises to help warm up the muscles[2][5].
Anti-inflammatory Medicines
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be recommended to manage pain and inflammation[2][5].
Exercises for Posterior Tibial Tendonitis
Inversion Exercises with Resistance Band
This exercise directly loads the posterior tibialis tendon, helping to retrain and remodel it.
Loop a band around the ball of the foot, using the other foot as an anchor.
Lift the foot towards the ceiling against the resistance of the band.
Aim for 3 sets of 10 reps, focusing on the eccentric (lowering) phase. Progress from a yellow band to orange/red and finally green as strength improves[3][4].
Heel Raises
Heel Raise: Up on 2 / Down on 2
Stand with heels together and rise onto the balls of the feet. Hold on for balance if needed.
Work up to 50 repetitions, completing 5-7 times per week[1].
Heel Raise: Up on 2 / Down on 1
Rise onto the balls of both feet, then lift the unaffected leg and lower down on the affected foot only.
Keep weight over the ball of the foot when lowering down. Work up to 50 repetitions, completing 5-7 times per week[1].
Heel Raises with Ball Squeeze
Place a ball between the heels and pinch the ball as you lift the heels up and down.
This helps in turning the ankle inward in a controlled manner[4].
Isometric and Isotonic Inversions
Isometric Inversion
Loop a band around the foot and hold the foot in an inverted position for 45 seconds.
Repeat 4 times[4].
Isometric Inversion Through Range
Move the foot back and forth without allowing it to drop down, maintaining the position throughout in a slow and controlled manner.
Hold for 45 seconds, repeating 4 times[4].
Isotonic Inversion
Lift the foot up against the resistance of the band to a neutral position and then bring it back down.
Aim for 3 sets of 20 repetitions[4].
Forward Step Downs
This exercise strengthens the quadriceps and soleus muscles, which helps in reducing the load on the posterior tibialis tendon.
Step forward with one foot and lower the body down until the back knee almost touches the ground.
Push back up to the starting position. Repeat on both sides[3].
Slant Board Raises
Stand on one foot on the edge of a slant board with a relaxed foot.
Raise the arch without scrunching the toes up, focusing on shortening the distance between the big toe and the heel bone.
Aim for 3 sets of 25 repetitions[4].
Eversion and Inversion with Exercise Band
Eversion
Secure the band around both feet, starting with feet pointing inward.
Pull against the resistance of the band until the feet point upward, moving only the ankles.
Work up to 200 repetitions, progressing from a yellow band to orange/red and finally green[1].
Inversion
Cross the unaffected leg over the affected leg and secure the band around the ball of the affected foot.
Use the other foot as a fulcrum and pull the foot inward against the resistance of the band.
Work up to 200 repetitions, progressing from a yellow band to orange/red and finally green[1].
Additional Tips and Considerations
Physical Therapy
Physical therapy is crucial for strengthening the tendon and improving flexibility. It includes stretching the calf and Achilles tendon to reduce tightness in the ankle[5].
Orthopedic Aids
In severe cases, a cast or walking boot may be used to limit activity and reduce pain. Heel lifts or arch supports (orthotics) can also be beneficial[2][5].
Prevention
To prevent posterior tibial tendonitis, ensure proper warm-up and stretching before practice or competition, use correct technique, allow time for rest and recovery, maintain ankle and leg stability, and wear arch supports if you have flat feet[2].
Most Important Facts
Rest and Activity Modification: Reduce or stop activities that exacerbate the pain and switch to low-impact exercises.
Use of Ice and Heat: Apply cold packs to reduce swelling and use heat before stretching and strengthening exercises.
Anti-inflammatory Medicines: Use NSAIDs as directed by your healthcare provider to manage pain and inflammation.
Inversion Exercises: Use resistance bands to load the posterior tibialis tendon directly, helping in its retraining and remodeling.
Heel Raises: Perform various heel raise exercises to strengthen the muscles around the tendon.
Physical Therapy: Engage in physical therapy to strengthen the tendon and improve ankle flexibility.
Orthopedic Aids: Use casts, walking boots, heel lifts, or arch supports as necessary to support recovery.
Prevention: Ensure proper warm-up, technique, rest, and recovery, and maintain ankle and leg stability to prevent the condition.
By following these exercises and treatment guidelines, individuals with posterior tibial tendonitis can effectively manage their symptoms and work towards a full recovery. Always consult with a healthcare provider before starting any new exercise program.
