Physical Therapy Exercises for Posterior Tibial Tendonitis

Posterior tibial tendonitis is also known as PTT dysfunction. If you have the condition, you may benefit from physical therapy. Physical therapy exercises can improve the range of motion (ROM) in your ankle. They also help with flexibility, strength, and balance.

This article will talk about the different physical therapy exercises that are used to treat PTT dysfunction.

Physical Therapy for PTT

Posterior tibial tendon dysfunction (PTT) makes the inner part of your foot or ankle hurt. The pain can make it harder for you to walk or run. Working with a physical therapist can help make the pain better so you can get back to your usual activities.

The goals of therapy for PTT dysfunction are:

  • Helping the foot and ankle move without pain
  • Improving foot and ankle range of motion (ROM)
  • Making the foot and ankle stronger
  • Improving foot position with exercise or special shoe cushions called orthotics
  • Helping you return to your normal level of functioning

​Your physical therapist can use different techniques to help you. For example, they may use:

Exercises should be the focus of your physical therapy program. Research has shown that specific exercises are a good way to treat PTT. The key is knowing which exercises to do and when to do them. Your physical therapist will help you figure out the best exercise program for your condition.

Before you start doing exercises for PTT dysfunction, talk to your doctor. They can make sure that it's safe for you to start doing them.

1

Range of Motion

Photo of a PT examining a woman's foot.

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Your physical therapist will want you to do range of motion (ROM) exercises. The exercises help your foot and ankle move fully in all directions without pain.

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

Active ankle ROM exercise includes four directions of motion:

  • Pulling your toes and ankle up (dorsiflexion)
  • Pointing your toes and ankle down (plantarflexion)
  • Moving your foot and ankle inwards (inversion)
  • Moving your foot and ankle to the side and away from the midline of your body (eversion)

Ankle ROM exercises for PTT dysfunction should not hurt. If you feel pain when doing the exercises, stop and tell your physical therapist.

2

Stretches

Photo of a woman stretching her calf.

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Your physical therapist can give you some stretching exercises for your foot and ankle. Here are a few examples:

Hold these stretches for 20 to 30 seconds. You can do them several times a day.

Flexibility exercises for PTT dysfunction help the muscles around your foot and ankle move better. They also help make sure your feet are lined up the right way when you're walking and running.

Recap

ROM exercises and stretching can help the muscles in your ankles and feet move better. The goal is to be able to move freely and without pain.

If your feet or ankles hurt when you do these exercises, stop and tell your physical therapist.

3

Ankle and Foot Strengthening

Woman Exercising With Resistance Bands

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Ankle strengthening exercises add stability to your foot and ankle. This takes the stress and strain from your injured posterior tibialis tendon.

One of the easiest ways to strengthen your ankles is with a latex rubber band called a resistance band. You wrap the band around your foot to create resistance as you move.

Here are a few exercises you can do with resistance bands:

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

Doing these exercises should not hurt. However, they will make your ankle and foot feel a little tired.

If the exercises are easy, you can make them more challenging by using a thicker band. Doubling up a resistance band can also increase the tension.

You can also do exercises to make the muscles in your feet stronger. This supports the natural arch in your foot, which takes the pressure off your injured tendon.

Foot exercises have you use your toes like you would use your fingers. Here are a few examples:

  • Scrunching up a towel with your toes
  • Picking up a tissue with your toes
  • Pulling your toes against a light resistance band

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

4

Hip and Knee Strengthening

Photo of woman running with hip muscles exposed.

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Your hips and knees keep your lower body in the right position. Strengthening the muscles in your hips and knees helps make sure your foot is in the correct position when you're moving.

Here are some examples of exercises that can make your hips stronger:

Exercises for the muscles around your knees focus on your quadriceps and hamstrings. Here are a few examples of knee-strengthening exercises:

Do these exercises for eight to 15 repetitions. Move slowly through the full movement. If any exercise hurts, stop and check in with your physical therapist.

Recap

Strengthening exercises help keep your body in the right position when you walk and run. These exercises can work your feet, ankles, hips, and knees.

5

Balance and Proprioception

Photo of a girl balancing on a log.

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Balance and proprioception exercises are a key part of a physical therapy program. Proprioception is your ability to figure out where your body is and how it's moving.

Better balance and awareness of the position of your foot and ankle can decrease the stress on your injured tendon.

Balance exercises can start out simple, like a single-leg stance progression. More advanced exercises could be standing on a foam pad with one foot and catching a ball. You could also stand on the pad and squat down slowly.

Your physical therapist might use tools to make the exercises work better for you. Here are a few examples of tools you might use:

Balance exercises should be done slowly and with control. Don't worry if they are hard to do at first. Try not to get discouraged if you don't see results right away. It can take a few weeks to see improvement.

6

Plyometrics

Photo of an athlete doing a box jump.

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Plyometrics are exercises that use your body's ability to jump and land with explosive power. They enable you to quickly run, change direction, and take the forces on your body as you're running and jumping.

Your physical therapist may include plyometric exercise as part of your posterior tibial tendonitis rehab. If you are an athlete trying to get back to playing pain-free, this type of training will be important.

Your physical therapist will likely wait until later in your rehab to start plyometric training. You need to have very good strength, balance, and proprioception to handle the forces it puts on your body.

Examples of plyometric exercises include:

  • Drop jump
  • Single leg hopping
  • Hopping or jumping in different planes of motion and directions

Be careful when you're doing plyometric training. Your body needs to always be in the proper position while you are exercising to prevent injury.

Your physical therapist can watch you do the exercises and make sure you're doing them the right way.

Recap

Good balance supports your lower body as you move. When you have made progress in your physical therapy program, your therapist may show you plyometric exercises that can improve your balance.

7

Returning to Activty

Photo of woman hopping while running.

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After a few weeks of doing physical therapy exercises for PTT dysfunction, your physical therapist might add functional exercises like running or jumping.

These movements will be specific to your needs. For example, if PTT dysfunction is keeping you from running or participating in a sport, then your therapist will gear the exercises to that sport.

As you return to your normal activities, you might notice that your symptoms come back a little bit. Doing too much too soon could undo the gains you've made.

You'll need to ease back into your regular activities. Your physical therapist will guide you and make sure you're progressing at a safe rate.

When to See Your Healthcare Provider

PTT dysfunction usually gets better in six to eight weeks. If you are not recovered by then, you might need another treatment. Some patients get cortisone injections for their tendonitis. Others need surgery to fix the injury.

Summary

Posterior tibial tendonitis (PTT) dysfunction can be treated with physical therapy exercises. The focus of a physical therapy program for PTT is on the feet and ankles.

Range of motion exercises and stretching helps keep the muscles in your feet and ankles strong. These exercises also support the other muscle groups that keep your lower body in the right position. It's also important to improve your balance.

A Word From Verywell

Foot and ankle pain from posterior tibial tendonitis (PTT) dysfunction can keep you from taking part in your normal activities.

Most cases of PTT dysfunction can be treated with physical therapy. Exercises that help your ankle and foot move and function better are a key part of rehab for PTT. If you have foot and ankle pain, working with a physical therapist can help you get back to your favorite activities without pain.

However, if you don't notice improvement after six to eight weeks of therapy, you might need to have other treatments. You may need cortisone injections or surgery to fix PTT.

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  1. Blasimann A, Eichelberger P, Brülhart Y, et al. Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial. J Foot Ankle Res. 2015;8:37. doi:10.1186/s13047-015-0095-4

Additional Reading
  • Kulig K, Reischl SF, Pomrantz AB, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Phys Ther. 2009;89(1):26-37.

  • Ross MH, Smith MD, Mellor R, Vicenzino B. Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ Open Sport Exerc Med. 2018;4(1):e000430.

  • Safran M, Zachazewski JE, Stone DA. Instructions for Sports Medicine Patients. Elsevier Health Sciences; 2011.