Posterior Tibial Tendon Pain Exercises

Your home program

Load the tendon while watching the shape and function of the foot.

The best exercise dose is uncertain. Small trials mainly studied strengthening together with foot orthoses and stretching, not exercise in isolation. A supportive shoe, arch support, brace, or temporary immobilization may be appropriate based on walking tolerance and deformity and should be individualized.

Frequency

Strength 2 to 3 nonconsecutive days per week; balance 2 to 3 days per week

Equipment

Resistance band, supportive shoe, stable support, optional small ball and weight

First checkpoint

Review the trend at 6 weeks; build for 8 to 12 weeks or longer

Primary goal

Restore push-off, walking, stairs, hills, and appropriate return to running

1. 01
   Exercise 1

   Banded foot adduction

   2 to 3 days per week

   Dose3 to 4 sets of 12 to 15 repetitions

   Sit with both knees bent and the foot in a supportive shoe. Anchor a band outside the forefoot at about 45 degrees to the floor. Keep the heel and leg quiet, slide the forefoot inward, then return over three seconds without clawing the toes.

   Make it easier

   Use no band, a shorter range, or four low-effort isometric holds of 20 seconds.

   Progress it

   Use a stronger band or a four-second return.

   My starting dose or notes

2. 02
   Exercise 2

   Heel raise with controlled heel direction

   2 to 3 days per week

   Dose3 sets of 8 to 15 repetitions

   Keep the base of the big toe grounded, rise as high as controlled, allow the heels to turn slightly toward each other, then lower over three seconds. A small ball between the heels can guide the motion, but do not force an arch position.

   Make it easier

   Use a seated or double-leg version with hand support.

   Progress it

   Progress to one leg, then add weight or use a step after 15 controlled repetitions.

   My starting dose or notes

3. 03
   Exercise 3

   Supported single-leg balance

   2 to 3 days per week

   Dose3 rounds of 30 to 60 seconds per side

   Stand near a stable support and let the foot move naturally within a tolerable range while the knee and pelvis remain controlled.

   Make it easier

   Use fingertip support or keep the opposite toes on the floor.

   Progress it

   Add three-way reaches or slow trunk rotations.

   My starting dose or notes

4. 04
   Exercise 4

   Squat to chair or supported split squat

   2 to 3 days per week

   Dose2 to 3 sets of 8 to 15 repetitions

   Keep the whole foot grounded and move through a comfortable range with a stable chair or rail nearby.

   Make it easier

   Use a higher chair, shallower range, or more support.

   Progress it

   Use a lower chair, split squat or reverse lunge, then add light weight.

   My starting dose or notes

5. 05
   Exercise 5

   Supported single-leg hip hinge

   2 to 3 days per week

   Dose2 to 3 sets of 6 to 12 repetitions per side

   Stand on one leg near a stable support, soften the knee, hinge at the hip without twisting, then return upright with controlled foot pressure.

   Make it easier

   Use kickstand toes and hand support.

   Progress it

   Progress to a single-leg deadlift, add a knee drive, or hold weight in the opposite hand.

   My starting dose or notes

Symptom response

Let the next day guide the dose.

Establish a repeatable daily step baseline. If walking is provocative, temporarily use cycling or swimming. Increase steps, pace, hills, or running one variable at a time while monitoring gait, push-off, swelling, and foot shape.

Progression

Build capacity in stages.

1. Stage 1: reduce overload and establish support

   Track daily steps. Consider supportive footwear or clinician-directed arch support. Use banded adduction, seated or double-leg heel raises, and supported balance.

2. Stage 2: build tendon and calf capacity

   Progress adduction resistance, double-leg to single-leg heel raises, and squat, split-squat, or hip-hinge strength. Advance only after several stable next mornings.

3. Stage 3: restore walking and stairs

   Add weighted heel raises, dynamic balance, step and lunge demands, then brisk walking and hills one variable at a time.

4. Stage 4: return to running or sport when appropriate

   Use a graded walk-jog progression, then optional pogos, hops, and cutting only when there is no progressive deformity or instability and the examination supports impact loading.

Signs you are ready for the next stage

• Thirty minutes of level walking and normal stairs do not worsen the next morning.
• Twenty controlled single-leg heel raises can be completed with useful height and the base of the big toe grounded.
• The arch and heel position do not show progressive change during loading.
• Single-leg balance can be held for 45 to 60 seconds.
• Ten controlled step-downs can be completed without a sustained flare.
• Impact begins only after 20 small pogos are tolerated and after clinician review when foot collapse was ever suspected.