As a physical therapist, I’ve encountered many active adults who, despite their best efforts to stay fit and healthy, find themselves sidelined by injuries they never saw coming. One such injury that can sneak up on even the most seasoned athletes is tibialis posterior tendonitis. This condition is not only painful but can also seriously interfere with your ability to run, hike, or engage in other physical activities that you enjoy. The good news is that with early intervention and the right exercises, you can manage this condition effectively and prevent it from becoming a chronic issue.
Understanding Tibialis Posterior Tendonitis
To understand tibialis posterior tendonitis, it’s essential to first understand the role of the tibialis posterior muscle and its associated tendon. The tibialis posterior is a key muscle located deep within the calf, running along the back of the shinbone (tibia). It’s responsible for supporting the arch of your foot and stabilizing the ankle during movement. The tendon of the tibialis posterior runs down the inside of your ankle and attaches to several bones in the foot, making it a vital structure for maintaining proper foot mechanics.
When the tibialis posterior tendon becomes irritated or inflamed due to overuse, repetitive stress, or improper foot mechanics, tibialis posterior tendonitis can develop. This condition is common among runners, hikers, and other athletes who engage in activities that involve repetitive foot and ankle movements. The constant strain placed on the tendon, especially when running on uneven surfaces or using unsupportive footwear, can lead to micro-tears in the tendon fibers, resulting in inflammation, pain, and swelling.
How Tibialis Posterior Tendonitis Presents
Tibialis posterior tendonitis typically presents with a dull, aching pain along the inside of the ankle and foot. This pain often intensifies during activities that require you to push off the foot, such as running, climbing stairs, or even walking for extended periods. Over time, you might also notice swelling in the affected area, particularly around the inside of your ankle. In more advanced cases, the condition can lead to a noticeable flattening of the arch, as the tendon loses its ability to support the foot properly.
Another common symptom is a sense of instability in the ankle, especially during activities that require balance or involve uneven terrain. You might find it difficult to stand on one foot or feel wobbly when performing exercises that require ankle stability. This is because the tibialis posterior tendon plays a crucial role in controlling and stabilizing the foot during these movements. If the condition is not addressed early on, it can lead to compensatory changes in your walking or running gait, as your body tries to avoid pain and instability, potentially causing further issues in the knees, hips, or lower back.
The Impact on Activities Like Running
For physically active adults, especially runners, tibialis posterior tendonitis can be a significant setback. Running places a considerable amount of stress on the foot and ankle, and the repetitive impact can quickly exacerbate an inflamed tendon. As the pain worsens, you may find yourself unable to run your usual distances or having to stop altogether to avoid aggravating the condition. This can be incredibly frustrating, particularly if running is your primary form of exercise or a crucial part of your mental health routine.
Moreover, if tibialis posterior tendonitis is left untreated, it can lead to a cascade of other injuries. When you start altering your gait to avoid pain, you may inadvertently place additional stress on other parts of your body, such as your knees, hips, or lower back. This can result in a series of compensatory injuries that are even harder to manage than the original tendonitis. That’s why it’s so important to address tibialis posterior tendonitis as soon as you notice symptoms, to prevent it from developing into a more serious condition that could keep you sidelined for months.
3 Exercises to Combat Tibialis Posterior Tendonitis
Managing tibialis posterior tendonitis involves a combination of rest, activity modification, and targeted exercises to strengthen the affected area. The following three exercises are designed to help you address the condition by strengthening the tibialis posterior muscle and improving the stability of your ankle.
1. Ankle Inversion Swings
One contributing factor to this pathology is usually an increased amount of pronation in the foot. Pronation is when your heel kicks out and your foot becomes more flat. This stretches out the tibialis posterior tendon and puts it at a disadvantage to contract. Thus correcting this alignment is crucial in correcting the pathology.
How to perform:
- Stand with your hands against the wall and your feet a good distance away from the wall.
- The problem foot should remain on the ground in the back, while the opposite foot should swing forward and across the body.
- Allow the leg to rotate out, and the back foot to roll onto the outside of the foot.
- Perform 15-20 repetitions.
Tips:
- You can step the front foot forward and across and stay in this position for a good calf stretch. Being in this position will help the foot to supinate, allowing you to stretch the calf and achilles without aggravating the tibialis posterior tendon.
2. Resisted Ankle Inversion
Resisted ankle inversion is a powerful exercise that directly targets the tibialis posterior muscle, helping to build strength in the muscle and reduce strain on the tendon. By regularly performing this exercise, you can enhance the stability of your ankle and support the arch of your foot, which is crucial for preventing further injury.
How to Perform:
- Sit on the floor with your legs extended in front of you.
- Loop a resistance band around the arch of your foot, and secure the other end to a stable object or hold it with your hand.
- Slowly turn your foot inward against the resistance of the band, focusing on a controlled and steady movement.
- Hold the inward position for a few seconds, then slowly return your foot to the starting position.
- Perform 10-15 repetitions for 2-3 sets, increasing the resistance as you become stronger.
Tips:
- Ensure that the movement is slow and deliberate to fully engage the tibialis posterior muscle.
- Start with a lighter resistance band and gradually increase the resistance as your strength improves. This will help you avoid overloading the tendon and causing further irritation.
3. Heel Raise with Resisted Inversion
The heel raise with resisted inversion is a combination exercise that works the tibialis posterior muscle from multiple angles. By adding the inversion component to a traditional heel raise, you challenge the muscle to both lift the heel and stabilize the ankle, promoting better arch support and overall foot mechanics.
How to Perform:
- Stand with your feet shoulder-width apart, holding onto a stable surface for balance if necessary.
- Wrap a resistance band around the arch of your foot and secure the other end to a sturdy object.
- As you rise onto the balls of your feet (heel raise), simultaneously turn your foot inward against the resistance of the band.
- Hold the top position for a moment, then slowly lower your heels back down while maintaining the inward pressure.
- Complete 10-15 repetitions for 2-3 sets.
Tips:
- Focus on maintaining the inward turn of your foot throughout the entire movement to engage the tibialis posterior muscle effectively.
- If you experience discomfort or strain, reduce the resistance of the band or perform the heel raises without the band until you build up sufficient strength.
The Importance of Early Intervention
One of the most critical aspects of managing tibialis posterior tendonitis is early intervention. While it may start as a minor irritation, this condition can quickly escalate into a more serious problem if not addressed promptly. The exercises outlined above are designed to strengthen the tibialis posterior muscle and improve the stability of your ankle, which can alleviate pain and prevent further injury. However, the key to success is starting these exercises as soon as you notice symptoms. The longer you wait, the greater the risk of developing more severe complications, such as tendon degeneration or chronic pain.
In addition to these exercises, it’s essential to modify your activities to reduce stress on the tendon. This might mean temporarily cutting back on running or switching to low-impact activities like swimming or cycling while your tendon heals. Proper footwear that supports the arch and reduces strain on the tendon can also make a big difference in your recovery. Foot orthotics or supportive shoes can help maintain proper foot alignment, further reducing stress on the tibialis posterior tendon.
Conclusion
Tibialis posterior tendonitis is a condition that can significantly impact your ability to stay active, but with the right approach, it’s manageable. By understanding the pathology of the condition and incorporating targeted exercises like ankle inversion swings, resisted ankle inversion, and heel raises with resisted inversion into your routine, you can strengthen the affected area and get back to your favorite activities without pain. Remember, early intervention is key—don’t wait until the pain becomes unbearable to start taking action. Your feet, and your overall mobility, will thank you!
If you’re struggling with a current foot or ankle related injury that is holding you back from participating in the activities you love, don’t wait. Contact us today to get custom treatment and a plan tailored to your needs, designed to help you reach your goals!
Refrences
Evaluation and Treatment of Posterior Tibialis Tendon Insufficiency in the Elderly Patients
