Physical Therapy for Posterial Tibial Tendonitis

The posterior tibialis is a muscle in the lower leg that inverts and points the foot downward. The posterior tibial tendon attaches the muscle belly to several places on the inside and bottom of the foot. Posterior tibial tendonitis is a repetitive microtrauma that can occur with motions like jumping, running, or cutting. Physical therapy to treat it can include exercises, stretching, therapeutic modalities and medications.

Exercises

• Exercises are used to help regain strength and balance in the posterior tibialis. The tension can also help align collagen fibers in the tendon while it is healing. Simple exercises such as heel raises (stand on your tiptoes to raise your heels off the ground), wobble board (balancing on uneven surface), alphabets (write the alphabet in the air with your toes, moving only your ankle), and foot inversion (turn your foot inward moving just your ankle, not the knee) can all be performed.

Stretching

• The goal of stretching is to lengthen the muscle and tendon, thereby increasing the range of motion and decreasing pain. Injuries often result from limited mobility, so stretching the muscles in the back of the leg is beneficial to someone with posterior tibial tendonitis. Calf stretching can be done by standing on a step with the ball of your foot and dipping your heel downward until you feel tension in the back of your lower leg. A towel can also be used to pull upward on the front of the foot while sitting.

Therapeutic Modalities

• Various modalities can provide pain relief and optimum healing conditions for the tendon. These include electrical stimulation (to alleviate pain), ultrasound (to stimulate healing or produce a heating effect), ice massage (to induce numbness so exercises can be done pain-free), cross-friction massage (to align collagen and increase blood flow), and use of a warm whirlpool (to relax muscle spasm and increase blood flow). These therapies are often performed by a physical therapist or certified athletic trainer.

Medications

• Tendonitis is first and foremost an inflammatory condition. If the inflammation has been present for several weeks or months, it might impede the healing process. In that case, it can be necessary to prevent inflammation with non-steroidal anti-inflammatory drugs, or NSAIDs. These are over-the-counter medications such as ibuprofen. More potent anti-inflammatory drugs such as naproxen might be prescribed by a physician if the condition is severe.

Orthotics

• Because posterior tibial tendonitis can be caused by improper foot mechanics, specially designed orthotics can be made to fit inside the patient's shoe. These correct the condition (usually foot pronation) and help train the muscles to function normally again.