Tibialis Posterior Tendonitis Exercises

The Tibialis Posterior tendon tends to get injured in the inner side of the ankle/foot.

tibialis posterior tendonitis

This can lead to inflammation of the Tibialis Posterior tendon (called Tibialis Posterior Tendonitis).

This blog post contains the best exercises to help fix Tibialis Posterior Tendonitis.

How To Fix Tibialis Posterior Tendonitis

STEP 1: Reduce Aggravation
STEP 2: Address Inflammation
STEP 3: Encourage Blood Flow
STEP 4: Massage
STEP 5: Strengthening Exercises
Minimize Hindfoot Eversion:
STEP 6: Increase Ankle Dorsiflexion
STEP 7: Manage The Foot Arch
STEP 8: Increase Big Toe Extension
STEP 9: Gradual Return To Activities

STEP 1Reduce Exposure To Aggravating Activities

Completely stop or reduce exposure to any activity that noticeably aggravates the symptoms in your ankle/foot.

Frequent exposure to the activities/positions/movements that aggravate the Tibialis Posterior Tendonitis pain will likely prolong the recovery time.

Activities that you will likely need to address:

  • Walking
  • Squatting
  • Hopping/Jumping
  • Running

Note: Do not completely rest your injury as this could lead to unnecessary deconditioning.

STEP 2Reduce Inflammation

A significant amount of inflammation in the Tibialis Posterior Tendon can be very sensitive and painful.

This may limit the ability to perform the suggested exercises on this blog post.

Here are some simple ways to reduce inflammation:

a) Anti-Inflammatory Gel

Apply an anti-inflammatory gel to the inner ankle region.

Do this 3 times per day.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths/types of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the inflammation.

Note: Please consult your Primary Care Provider before taking any medication.

c) Cold Therapy

Apply an ice pack to the inner ankle region for at least 10-15 minutes.

Do this 3-5 times per day.

Note: Do not apply the ice pack directly to the skin as you may develop an irritation on the skin.

d) Try Natural Products

It is suggested that taking turmeric, ginger, chia seeds and/or fish oil capsules are natural ways to help reduce the inflammation.

e) Cortisone Injection

The cortisone injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to reduce the inflammation and reduce the pain by numbing the area.

Talk to your Primary Care Provider to see if the cortisone injection is appropriate in your situation.

STEP 3Encourage Blood Flow

Increasing blood flow to the injured Tibialis Posterior tendon may assist with a quicker healing time.

Try this gentle exercise to help improve the circulation to the injured area.

a) Toe Points

increase blood flow to tibialis posterior tendon

Instructions:

  • Point your foot forwards.
  • Curve your foot inwards firmly.
  • Aim to feel a muscular contraction on the inner side of the ankle.
  • Do not push into any pain.
  • Hold for 5 seconds.
  • Perform 30 repetitions.

Note: Be careful not to point your foot too firmly as this may cause a cramp.

STEP 4: Releases

Releasing can help improve circulation, alleviate pain and reduce tension in the Tibialis Posterior Tendon.

a) Tibialis Posterior Tendon Massage

tibialis posterior tendon massage

Instructions:

  • Sit down on a chair.
  • Place your ankle on your other knee.
  • Use your finger tips to apply an appropriate amount of pressure onto the inner ankle region.
  • Perform circular motions over the painful areas.
  • Continue for 2 minutes.

Note: If massaging makes the pain significantly worse, this may indicate that the area is too sensitive to touch.

If this is the case – Consider applying less pressure and/or performing the massage when the sensitivity has subsided.

STEP 5: Tibialis posterior Strengthening Exercises

Performing strengthening exercises is an important step when addressing the Tibialis Posterior Tendonitis.

Try out the following exercises:

a) Exercise With Resistance Band

tibialis posterior exercise

Instructions:

  • Loop a resistance band around the base of the big toe.
  • Hold the other end of the band with the hand on the same side.
  • Pull on the band to create tension.
  • Anchor the resistance band to the outside of your knee.
  • Point your foot and toes forwards.
  • Curve your foot inwards firmly.
  • Aim to feel a muscular contraction on the inner side of the ankle.
  • Hold for 5 seconds.
  • Perform 30 repetitions.
  • Repeat 3 times.

b) Heel Raise with Ball

exercises for tibialis posterior tendonitis

Instructions:

  • Stand on the edge of a step.
  • Place a small ball between the inner region of both heels.
  • Squeeze and scoop up the ball between your ankles throughout this exercise.
  • Aim to feel tension on the inner side of both ankles.
  • Perform a heel raise.
  • Repeat 30 times.
  • Repeat 3 times.

c) Short Foot Exercise

short foot exercise

Instructions:

  • Stand with your feet facing forwards and shoulder width apart.
  • Whilst keeping your toes relaxed, proceed to scrunch the under-surface of your foot.
    • Drag the base of your big toe backwards towards the heel.
  • Keep the base of the big toe in contact with the ground.
  • Aim to feel a muscular contraction in the inner ankle region and under the foot.
  • Hold this for 5 seconds.
  • Repeat 20 times.
  • Repeat 3 times.

d) Eccentric Exercise For Tibialis Posterior

eccentric strengthening exercises for tibialis posterior tendonitis

Instructions:

  • Stand up.
  • Activate the muscles of the arch (Short foot exercise as shown above).
  • Try to keep as much of your body weight on this foot.
  • Step to the side with your other leg.
  • Allow the arch to drop as you step with the other foot.
  • Perform 30 repetitions.

e) Toe Taps

toe tap

Instructions:

  • Stand upright.
  • You can hold onto something for balance if required.
  • Activate the muscles of the arch (Short foot exercise as shown above).
  • Reach the foot of the other leg in front of you.
  • As you are reaching your foot forwards, make sure that you are applying a downward pressure at the base of the big toe.
  • Perform 30 repetitions.

Minimize Excessive Hindfoot Eversion

The following 3 steps help reduce the load on the Tibialis Posterior Tendon by minimizing excessive amount of Hindfoot eversion during walking.

hindfoot eversion

Hindfoot Eversion is where the heel collapses inwards as you place your weight through the foot.

This ankle position tends to over lengthen the tendon.

By minimizing this collapse, there is less eccentric load on the Tibialis Posterior Tendon.


STEP 6Increase Ankle Dorsiflexion

Ankle Dorsiflexion is the movement where the ankle is bent in a backwards direction.

If you lack ankle dorsiflexion, this may lead to hindfoot eversion whilst walking.

Try out this quick test to determine if you have an adequate amount of movement in your ankle.

Knee To Wall Test

how to measure ankle dorsiflexion

Instructions:

  • Face a wall.
  • Assume a lunge position and have the front of the knee in contact with the wall.
  • Whilst keeping your knee in contact with the wall, move your foot backwards with the aim to get the front of your toes as far away from the wall.
  • Keep your heel in contact with the floor.
  • Maintain your foot arch.
  • Measure the distance between the tip of your big toe and the wall.

My recommendation: Aim to get the tip of the big toe approximately >4 inches from the wall.

For a complete guide on how to increase your Ankle Dorsiflexion:

See Post: Ankle Dorsiflexion

To get you started, try out these 3 exercises:

a) Gastrocnemius Stretch

gastrocnemius stretch

Instructions:

  • Stand in front of a wall.
  • Place the under surface of the forefoot onto the wall.
  • Bring your heel as close to the wall as possible.
  • Keep your leg completely straight throughout this stretch.
  • Lean your body forwards.
  • Aim to feel a stretch in your calf muscle.
  • Hold this stretch for at least 30 seconds.
  • (For more stretches: Gastrocnemius Stretches)

b) Soleus Stretch

soleus stretch

Instructions:

  • Assume the lunge position with back leg bent. (see above)
  • Sink your body weight onto your back leg.
  • Think about getting your shin bone as close to the floor as possible.
  • Do not allow your heel to lift off the floor.
  • Aim to feel a stretch in the back of your calf.
  • Hold for 30 seconds.
  • (For more stretches: Soleus Stretches)

c) Ankle Mobilization

ankle band mobilization

Instructions:

  • Attach a resistance band to something behind you. (Make sure it doesn’t move!)
  • Lace the band around your ankle.
    • Make sure the band is below the bumps on side of the ankle.
  • Move away from the anchor point as to increase tension in the band.
  • Assume the lunge position with your ankle on a bench. (see above)
  • Lunge forward.
  • Do not allow for your foot arch to collapse.
  • Repeat 30 times.

STEP 7Arch Control

Having a flattened or high arch in your feet has the potential to lead to hindfoot eversion during walking.

a) Flattened Arch

flat feet

With a flattened arch, the whole foot (including the hind foot) tends to roll inwards during walking.

For a complete guide on how to address Flat Feet:

See Post: Flat Feet Exercises

b) High Arch

HIGH ARCH

With a high arch, the hindfoot tends to roll inwards (evert) during walking to compensate for the stiffness in the midfoot region.

For a complete guide on how to address High Arches:

See Post: High Arches

c) Medial Heel Wedge

A medial heel wedge is an insert that you place in your shoe to help minimize the amount of hindfoot eversion.

Whilst you are addressing your flat foot or high arches (with the blog posts mentioned above), you may want to consider wearing the medial heel wedge in the short term to minimize the chance of aggravating the Tibialis Posterior Tendonitis.

(Note: I do not recommend relying on external supports (including orthotics) in the long term.)

STEP 8Increase Big Toe Extension

If your big toe is limited in its ability to bend backwards (also known as Big Toe Extension), this can influence how you walk.

How to Check Big Toe Extension

how to measure big toe extension

Instructions:

  • Place your foot on the floor.
  • Hold your big toe.
  • Lift it up.
  • Measure the angle of the big toe to the horizontal.

Results: Aim to have 60-70 degrees of big toe extension.

Here are some exercises to Increase Big Toe Extension:

a) Release Under The foot

Tightness in the muscles underneath the foot can limit the amount of big toe extension.

release under foot

Instructions:

  • Place a massage ball underneath your foot.
  • Apply an appropriate amount of your body weight on top of the massage ball.
  • Roll the foot forwards/backwards.
  • Continue for 1-2 minutes.

b) Big Toe Traction

Tightness in the big toe joint may reduce the amount of extension occurring in the big toe.

big toe joint traction

Instructions:

  • Sit down on a chair.
  • Place your ankle on top of the other knee.
  • Hold onto the mid foot with one hand.
  • Use the other hand to grip onto the base of the big toe.
  • Pull the big toe away from the rest of the foot.
  • Hold for 30 seconds.
  • Repeat 3 times.

c) Big Toe Stretch

big toe extension stretch

Instructions:

  • Kneel down on the floor.
  • Make sure that the toes are bent backwards.
  • Shift your body weight on top of your toes and forefoot.
  • Aim to feel a stretch under the foot.
  • Make sure that there is no pinching pain at the top of the base of the big toe.
  • Hold this position for 2-5 minutes.
  • Push the big toe into the floor for 30 seconds.
  • Relax.
  • Repeat

Note: If you have knee issues, please be careful with the kneeling position. You can place a pillow underneath the knees if required.

d) Big Toe Extension Strengthening

big toe extension strengthening

Instructions:

  • Keep your foot on the floor.
  • Lift up your big toe as high as you can.
  • Aim to feel a contraction of the muscles at the top of your big toe.
  • Hold for 5 seconds.
  • Repeat 20 times.

e) Push off Big Toe

This exercise will help the big toe to extend during walking.

big toe strengthening in standing

Instructions:

  • Assume a staggered stance position as shown above.
    • (The foot at the back will be the side targeted.)
    • Make sure that your big toe is extended back as far as possible without compromising the alignment of your foot.
  • Push the tip of your big toe into the ground as you point your foot against the ground.
    • Place as much of your body weight onto the back leg that you can comfortably tolerate.
  • Place your foot back onto the floor.
  • Repeat 20 times.

STEP 9Gradual Return To Activity

As the symptoms start to improve with the exercises, aim to gradually return the activities that were initially aggravating the Tibialis Posterior Tendon (if appropriate).

This progression might look something like the following:

Slow walking > Walking longer distances > Walking quicker > Walking up hill > Slow jogging > Running

The goal here is to find the most stimulating activity that your injury can comfortably tolerate.


Conclusion

Follow this blog post for the best exercises to completely fix Tibialis Posterior Tendonitis.


What to do next

1. Any questions?… (Leave me a comment down below.)

2. Come join me:

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3. Start doing the exercises!


Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before attempting any exercise. For more informationMedical Disclaimer.

2 thoughts on “Tibialis Posterior Tendonitis Exercises”

  1. Hi Mark.
    If only I had found your site earlier. Unfortunately I am 7 weeks post-op, having to undergo a heel osteotomy, FDL transfer and gastroc lengthening, believe me, I wish I had been advised of exercises which may of prevented the difficulties I now face.
    I am determined to try anything to rehabilitate my left foot.
    Are the exercises for posterior tibia tendonitis also suitable for post – op rehabilitation?
    I am 3 days out of the cast and wearing a boot and using crutches.
    Advice from physio has been very little and I don’t want look back with regret when I could possibly be doing something to aid my rehabilitation.
    Nor do I want to hamper my recovery.
    On a positive note I am following the exercise for my right foot in a hope of not repeating past mistakes.

    Reply
    • Hi Sallie,

      Yes – the exercises mentioned on this blog post can be used post op. However, to be on the safe side, please double check with your surgeon. I would also suggest that you be guided by the physio.

      You’ll eventually also need to progressively place more body weight on top of your foot. A great exercise for this is to stand in front of a kitchen bench top and place your hands on top of the bench for support/balance. Slowly shift a % of your bodyweight onto your foot and then back off again. Once again – you’ll need to be guided by the physio with this one!

      Mark

      Reply

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