Physical Therapy Exercises for Posterior Tibial Tendonitis

​If you have posterior tibial tendonitis, also known as PTT dysfunction, you may benefit from physical therapy exercises to help treat your condition. Physical therapy exercises for PTT dysfunction are designed to help improve your ankle range of motion (ROM), flexibility, and overall strength and balance. This can help you return to your normal, pain-free activity level.

Posterior tibial tendon dysfunction is a condition that results in pain in the inner part of your foot or ankle. The pain may limit your ability to walk or run normally. Working with your physical therapist can be a helpful way to get rid of your pain and get back to your normal activities.

The goals of therapy for PTT dysfunction include:

  • Eliminating your pain
  • Improve foot and ankle ROM
  • Improve foot and ankle strength
  • Improve foot position thru the use of exercise or orthotics
  • Help you return to normal activity and function

​Your physical therapist may use various treatment techniques to help you PTT dysfunction. These may include manual techniques, therapeutic modalitieskinesiology taping, and exercise.

Physical therapy exercises for PTT dysfunction should be a main component of your physical therapy program. Why? Because research shows that exercise can be an effective way to treat the problem. The trick is knowing which exercises to do—and when to do them—for your specific condition. Your PT can help you figure that out.

Before starting any exercise program for PTT dysfunction, see your doctor to ensure that exercise is safe for you to do.

1
Range of Motion

Photo of a PT examining a woman's foot.
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If you have PTT dysfunction, your PT will likely prescribe ROM exercises. The exercises are designed to ensure that your foot and ankle are able to move fully and painlessly in all directions.

Ankle ROM exercises may be active or passive. Passive ROM exercises simply means that your therapist will be moving your foot and ankle for you. You do nothing during passive ROM exercises.

Active ankle ROM exercise typically include 4 directions of motion. These are:

  • Dorsiflexion (pulling your toes and ankle up)
  • Plantarflexion (pointing your toes and ankle down)
  • Inversion (moving your foot and ankle inwards)
  • Eversion (moving your foot and ankle laterally and away from the midline of your body)

Ankle ROM exercises for PTT dysfunction should be done in a pain free way. If any increase in pain occurs, stop the exercise and check in with your PT.

2
Stretches

Photo of a woman stretching her calf.
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 Your physical therapist may prescribe stretching exercises for your foot and ankle if you have posterior tibial tendonitis. Stretches may include:

Stretches should be held for 20 to 30 seconds, and they can be repeated several times each day.

Flexibility exercises for PTT dysfunction can help improve the overall mobility in all muscle groups around your lower extremity, ensuring correct foot alignment while walking and running.

Stop any stretching exercise that causes increased pain in your foot or ankle.

3
Ankle and Foot Strengthening

Woman Exercising With Resistance Bands
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Your physical therapist may prescribe ankle strengthening exercises for your PTT dysfunction. These exercise are designed to add stability to your foot and ankle, thus taking stress and strain off your injured posterior tibialis tendon.

One of the easiest ways to strengthen your ankles is with a resistance band. These latex rubber bands can be wrapped around your foot to increase resistance as you move. Resistance band exercises for your ankle may include:

  • Ankle inversion
  • Ankle eversion
  • Anke dorsiflexion
  • Ankle plantarflexion

Exercises should be painless, and they should make your ankle and foot feel fatigued. If they are easy, you can make them more challenging by changing the resistance band; a thicker band means more resistance. (Doubling up a resistance band can also increase the tension.)

Exercises to strengthen your feet (yes, there are small muscles in your feet that control their position) may be prescribed by your PT to help support your foot. This can help you maintain a natural arch in your foot, taking pressure off your injured posterior tibial tendon.

Foot exercises may include scrunching up a towel with your toes, picking up a tissue with your toes, or pulling your toes up against a light resistance band.

All foot and ankle exercises can be done for eight to 20 repetitions, several a times a week.

4
Hip and Knee Strengthening

Photo of woman running with hip muscles exposed.
A solid hip exercise program can keep you injury free. Henning Dalhoff / Getty Images

Don't be surprised if your physical therapist prescribes hip and knee strengthening exercises for your PTT dysfunction. That's because your hip and knee help control the position of your entire lower extremity, including your foot and ankle. Strengthening the muscles around your hips and knees can help ensure that your foot is in the correct position while walking and running.

Hip strengthening exercises may include:

Exercises for the muscles around your knees focus on your quadriceps and hamstrings and may include:

Lower extremity strengthening exercises should be done for 8-15 repetitions, and care should be taken to move slowly through the range of motion. If any exercise causes pain, stop it and check in with your PT.

5
Balance and Proprioception

Photo of a girl balancing on a log.
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Balance and proprioception exercises may be an important component of your PTT rehab program. Why? Because improved balance and awareness of foot and ankle position has been shown to decrease stress through your injured posterior tibial tendon. This may help decrease pain and improve your ability to return to normal, pain-free walking and running.

Balance exercises may be simple, like the single leg stance progression. Advanced balance exercise may include standing on a foam pad with one foot while having a ball catch or while slowly squatting.

Tools in the PT clinic may also be used to improve your balance and proprioception. These may include:

Your balance exercises should be done slowly and with control. Don't worry if they are difficult at first; it may take a few weeks to see improvements in your balance.

Single leg standing balance exercises may also be prescribed as part of your home exercise program.

6
Plyometrics

Photo of an athlete doing a box jump.
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Plyometrics refers to your body's ability to jump and land with explosive power. It allows you to quickly run, change direction, and accept the forces that your body may encounter while running and jumping.

Your physical therapist may have you engage in plyometric exercise as part of your posterior tibial tendonitis rehab. This type of training is especially important if you are an athlete looking for a pain-free return to your previous level of sports participation.

If you have PTT dysfunction, you PT will likely wait until the latter stages of your rehab before beginning plyometric training—the forces imparted on your body require excellent strength, balance, and proprioception.

Exercises may include the drop jump, single leg hopping, and hopping or jumping in various planes of motion and directions.

Care should be taken when engaging in plyometric training; you need to be sure your body is in the proper position while exercising to prevent injury. Your PT can help make sure you are doing plyometric exercises correctly for your PTT rehab.

7
Returning to Activty

Photo of woman hopping while running.
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After a few weeks of performing PT exercises for PTT dysfunction, your physical therapist may progress your rehab to include functional exercises like running or jumping. These movements should be specific to your situation; if your PTT dysfunction prevents you from running or participating in your specific sport, then your PT should gear these exercise to that sport.

Returning to your normal activities may cause a slight increase or return of your symptoms, so care should be taken to gradually and progressively get back to your normal activity. Your PT can help guide you when getting back to your normal activities. Too much, too soon may reverse the positive gains you have made during rehab, so care should be taken to ease back into your normal activities.

Most cases of PTT dysfunction get better in 6 to 8 weeks. If your symptoms and functional loss continue after that time, you may benefit from visiting with a surgeon to discuss your options. Some patients benefit from cortisone injections for their tendonitis, and a few others may require a surgical intervention to correct the problem.

A Word From Verywell

Foot and ankle pain from posterior tibial tendonitis or dysfunction can prevent you from engaging in your normal activities. Don't worry; most cases of PTT dysfunction are treatable with conservative measures like physical therapy. Exercises to improve the way your ankle and foot move and function is an essential part of your PTT rehab.

If you have foot and ankle pain, visit your doctor to get an accurate diagnosis, and then work with your PT to correct your problem and return to your previous level of activity.

Source: Guelfi, M. etal. Anatomy, Pathophysiology, and Classification of Posterior Tibial Tendon Dysfunction. Eur Rev Med Pharmacol Sci.2017; 21: 13-19

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