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Posterior tibialis tendinopathy

Updated: Aug 31, 2023


Hey Dr. McNamara here and coming at you guys with a wellness Wednesday. And today I wanted to talk about another common running injury, which is called posterior tibialis tendinopathy. So the posterior tibialis muscle is a muscle that travels down the posterior tibia as the name implies, and then inserts onto a bone in the foot called them navicular bone.

So to help with this type of pain and these symptoms. What you wanna do first is do some intrinsic foot strengthening as well as some loosening of the tissue of the bottom of the foot. Great way to do that is to take a tennis ball and just work on that plantar fascia underneath the bottom of the foot.

That's generally tight for individuals that are suffering from this condition. This condition is also most common in individuals that will pronate their feet. So you can see, I have pretty flat feet. I'm not sure if you can see in the video, but I have a problem with over pronating my feet. So you may want to get some orthotics if you have that issue.

Otherwise you can do some intrinsic foot strengthening exercises such as the towel scrunch foot yoga and the short foot exercise, which I'll show you. Now, we're going to talk a little bit about just strengthening the intrinsic musculature of the feet. As you can see here, ignore the ugliness of my toes and the rest of my feet, but I have a great example of showing you where that attachment site is for that navicular bone, because I actually have an extra one where my posterior tibialis attaches to, which is right in there.

You can see that nice little bump there. I do have extra symptoms of pain when I do have this stuff going on because of that extra bone, but that's besides the point. So the first exercise we're going to be doing is called foot yoga. And the idea behind this one is to get a better motor control over our feet so we can move our toes more independently of each other.

To practice this exercise, what I want you to first be able to do is be able to lift the big toe up while you push the other toes down. Working on that dorsal flexion of that big toe, that great hallux. Next, you want to do the very opposite movement where you're gonna push the big toe down then lift up on the toes.

At this point, you may feel some contracting on the inside of the foot. That's good. That's gonna strengthen that arch for those of you with flat feet, then you want to repeat that a few times, and then when you start getting better at that, what I want you to focus on is doing one toe at a time. So see me grab the pinky toe, then the second toe, all the way to the big toe like that.

When you get good at this exercise, you can start doing the short loaf exercise, which is you're essentially gonna do the contraction where you're gonna push the big toe up and the other toes down and make it so your foot actually kind of shrinks in size. So can you see how my foot, that metatarsal getting closer to my heel. That's exactly what we want with this exercise. This, you can just repeat as needed as many times as you can throughout the day. You may even get some soreness on this part of your foot too. That's totally normal. And that's actually a good thing. We wanna strengthen that side as well.

The last exercise, we're gonna work on is just some toe scrunches with the towel. So what we're gonna do with this one is you're literally just going to curl up with the toe to start, just curl that towel get it closer to you with each repetition. And then when that starts getting a little bit easier for you and you start developing more of that motor control. What I then want you to try to do is doing it with only the four digits not using the big toe. So try to do that contraction where you're doing one at a time. And then curl it in, go one toe at a time, curl it in. And that's how we strengthen the intrinsic musculature of our foot.

After those short foot exercises, we're going to want to strengthen our foot and calf musculature as well, and really activate the posterior tibialis muscle. And the way we're gonna do that is we're going to work on our supination of the foot. So making the foot supinate and a great way to practice that is to come up to a wall and just start with some calf raises as long as that's not hurting.

Now to get that extra supination of the foot. What we're gonna do is you can put a little ball kind of in between the heels of your feet and you have to keep the ball in your foot. So that's gonna force you to push your heels together and supinate it like I was saying, that calf raise and that's really gonna activate that posterior tibialis. Just some simple calf stretching of the soleus muscle. As well as the gastrocnemius. And then since this muscle is so involved with the balance of our foot, another great exercise you can do, I'll do it right over here is you'll just stand and just work on balancing the foot and kind of holding that short foot position where you're making that arch.

And then as that gets easier, you can start adding in some kind of rotations, throw you off balance. And when you get better at that, you can stand on an unstable surface, which will make it even more difficult to hold that position. Really activate that posterior tib to stabilize that foot. And you can do the same kind of thing with some rotations.

That's all I got for you guys this week. Have a great week.

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