4 Ways to Prevent and Treat Posterior Tibial Tendon Dysfunction
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- čas přidán 2. 06. 2024
- Sharp pains in your arch or foot, Visible inflammation along the tendon. Stiffness in your ankle joint. A popping sensation. Sore to the touch. You’ve been running through the pain lately, but now it feels as if you can barely lift your heel off the ground.
Have you experienced any of these symptoms? If so, you are probably experiencing Posterior Tibial Tendon Dysfunction (commonly called Posterior Tibial Tendonitis). We’ll explore the anatomy of this tendon and tell you how to diagnose and treat PTTD.
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0:00 Introduction
1:04 What is the posterior tibial tendon?
2:37 The diagnostic test
3:58 Biomechanical and Clinical Factors Related to Stage I Posterior Tibial Tendon Dysfunction
6:31 Wear supportive shoes and orthotics
7:11 Calf stretching
7:43 Strength training exercises
9:38 Phase 1: Theraband Eversion
9:56 Phase 1: Theraband Dorsiflexion
10:38 Phase 2: Single-Leg Heel Raise
11:10 Phase 2: Toe Walking
11:27 Phase 2: Balance Board "Tapping"
Exercises and stretches start at 7:10, 8:44, 9:21, 9:38, 9:57, 10:39, 11:10, 11:28, 12:11
How long it takes to heal this injury?
Thanks for the time notes
I have beaten posterior tibial tendonitis in 9 months!
Read closely I am writing this because I would have died for someone to tell me this information when this first started when I though there was no way out. Now through all of these steps make sure to take Moringa, turmeric ,ginger and cocoa which are highly recommended for beating the inflammation (make sure to check with your doctor first to make sure these are safe for you to take 1st) and take collagen 1 and 3 preferably from green lakes or native path as well as tendoforte collagen from salt wrap or sparkling wellness which is a little cheaper. Now I was in agonzing pain with both ankles every time I would walk it literally felt like someone was shoving a staple through my tendon so it may depend on the amount of damage done with the time lapse needed on each step but I can only personally share my experience and if I would have done this the right way I probably could have healed a lot faster so here we go. Step 1. Relax your ankle for the first month to two always walk with a brace never unsupported as well as a shoe with a good orthotic always ( orthofeet reccomended) and ice to bring down infllammation I just shoved my foot in an ice bucket but any way is possible to help bring down the inflammation when walking supported gets noticeably easier its time for step 2.Step 2. once the inflammation stage starts to get better this is when stretching, rolling your legs and foot as well as taking longer walks comes into play but still always supported by an ankle brace or something just to keep you arch supported so the tendon can heal but take on a little pressure from the walking. Step 3. this should be at the 3 to 4th month time lapse once you are a professional at walking now comes strengthening a little bit more intensily with calf raises only off the ground I started with 5 the first day 10 the next until I finally made it to one hundred with out a problem from here you should be 65% improved if on any of these steps you do feel pain stop right away and go back to the earlier step you are not ready. Healing for me was a two feet ahead one step back process so be careful keep stretching and monitoring yourself. Step 4. Now when calf raises get easy start to use lotion and give your tendon a deep massage to tear up the tissue I would recommend watching a video on this first then as soon as soon as you are done walking or calf raises need to be done because the whole idea is that you are breaking up the scar tissue with the massage and realigning it with the exercise.Also start to motion your foot in a circle 5 times each way to improve mobility. By now you should be on month six and 85% better now its time for the final step. Step 5. Now at this point you should be more able to walk with out a cast unsupported not is when I started using the theraband I would point my calf down with the band on the ball of my foot and pull it in start with the weakest band start 5 then next day ten and until you can hit twenty then fifty by now you should be at almost 100%. Things to not do do not use n said cream I did this and luckily stopped and found out later it actually weakens the tendon long run. If your foot starts breaking down like all the tendons in my foot did stretch and stick in a bucket of ice every night eventually won't have to but from steps 2 to 4 this was a nightly ritual. Subliminal and mprphic fields may help speed up the process as well I definitely recommend sapien medicine for the fields. Like I said this can be done in a good amount of time if done right. Any question feel free to ask Good luck!
This is great advice. Jumping into exercises when the tendon is inflamed could do more damage.
Ice bucket is a great idea.
Thx for this thorough note
Such a high quality video..Pure explanation..
Really appreciate this video!
Thank you! Best video on PTT!
Really informative and helpful.
Thank you for the information. God bless you!
Thanks its really educative and helpful.
Awesome video! Thank you so much.
Great ,explanation, very professional,Thank you.
Great info, thanks!
great information, delivered clearly and concisely. I begin the protocol today!!! Let's hope....
I’m at the first stage of this injury so working through those stretches. Great video. Thank you
Thank you so much for this info.
Most informant video on CZcams!!! Learned so much from this video. Thanks!
Excellent overview! I will recommend this video to my patients.
Thanks for this info...
Appreciate it alot
Very useful info here.
I watched many videos. This one is the best. It has the most detailed information and exercise. Thank you.
This is exactly what I have, thanks for the video
You have explained better than my physiotherapist!! Thanks ! Happy new year 🎈
I have this injury, this video is a light at the end of the tunnel, thanks.
A very useful video. So often videos just demonstrate an exercise with no instructions for frequency. I like that you cover the different perspectives from different experts.
this is incredible
I love this video so much it has all the information I need, please could you do a video for the metatarsal 🙏
Thank you so much, this is such a good video. I've been struggling with my TP and TA tendons for a while and this video really helps to get a better understanding.
Thanks for the advice much appreciated, most of all keep well in these difficult times
Thanks, same to you Stuart!
Your informations are better than all doctors I met
yah man, this's so sad, Ive been to 2 drs and all they've said is just to relax the foot. Now I completed 4 moths of rest and the pain still exist :'(. Will definitely try these exercises
Thank you for this video.
Glad it was helpful!
I've seen a PT and a podiatrist for PTTD over the last year. There was a tear showing with ultrasound. I'm healing with rest. This video gives me so much information I need to rehab. Certainly want to make sure I do the right exercises. Thanks so much!
This is excellent and also applies to ballet dancers! I agree with the higher resistance and less reps for dancers. Thank you
Thank you so much for this video. You were able to tell me exactly what the problem was and how I could test and start to remedy it. Amazing channel. You have helped a very frustrated runner feel much better! Thank you! Better than my podiatrist!
This is my problem!! Thank you so much! No more runs this week. Will I’ve and start restrengthening.
Ruddy good video! 🧐🎩🤙🤙
Thank you for this. I have flat feet and have developed this injury. It has been months of no improvement and the protocol suggestion here is finally what i've been looking for.
Thank you
Great video with the literature review and exercise tips!
this is so helpful thank you. I've had this inner arch pain for years. also it's worse in the morning which sucks
I have PTTD from playing hard in a soccer game with poor cleats. I am also a runner with weak arches. Thanks for the video. I will do the exercises.
This is an awesome, in-depth video. Thank you for making this. I am a 30 year old male who recently started experiencing this condition and it is super frustrating, hard to describe and snuck up on me gradually. I had never had anything like it and I have played college football, so I've had a variety of injuries and seen many others injuries. I do have flat feet and I have broken this ankle a long time ago that I am having PTTD with now, so the orthopedist said that the scar tissue and flat foot eventually caught up to me. I can say that, for the beginning of stages of rehab that I am in now, resting, rolling out my calf and wearing orthotics has helped immensely already. Thanks again.
Yes, this video is very helpful. Thanks.
I have been doing this exercise and it works. The pain subsides and im pretty sure it will heal few days/weeks in the future. I guess i was at stage 1.
Was training for a marathon when I got injured. 🤕 It’s been months since I last ran tendon is SLOW to recover but hopefully these exercises will help!
Thanks
Be very careful before doing these exercises, especially the one with theraband inversion because it can irritate the tendon and flare up the pain. That's what I experienced a couple of weeks ago and it's pretty annoying to feel irritated even without doing any running exercises.
Thanks for the warning, Barish! Hoping you experience relief with symptoms soon!
@@runnersconnect thank you so much. This is definitely one of the most complete and informative videos I've seen so far, specifically addressing the issue among runners. Thumbs up and all the best from Turkey!
This is the exact problem I’m having Barish, the inversion exercise is causing my pain to flare up for days.. did you overcome this problem?
@@simonmccomb8670 Hello my friend, first of all, I'm sorry to hear that you're suffering from this stubborn injury. It has reoccurred twice in my case because I returned to running too soon too fast. I believe patience and gradual increase in exercises are key to heal and avoid any reoccurrence. First, you take a sufficient time of R.I.C.E. principle, and then you begin with exercises very gently. I'd avoid inversion exercises in the beginning as they irritate the tendon further. If you use a theraband, beging with the softest one, and change into harder ones after a certain time. Iceing after inversion exercise also helps to avoid irritation. Once you feel that you're ready to go for running exercises, begin with walking/jogging program and increase the exercise time and intensity very gradually. Watch if you have pain and irritation at night or the day after. Here's a very good walking/running exercise you can follow: www.sports-injury-physio.com/post/running-after-injury Hope this helps and you return to your running routine safely! All the best!
Barish, do you recommend ice massage using a small Dixie cup or a frozen bag of peas ( with a thin towel wrapped around it)? How many minutes doing the above and how often? Thank you!
Excellent video and thank you for making it! I have been suffering from PTTD for about two months and seeing some improvement with your recommendations. However, I have flat feet and accessory navicular syndrome. Orthotics or supportive running shoes only make my problem worse since the posterior tibial tendon tends to rub/press against the orthotic. I have never had arches and don't want surgery. What are your thoughts on minimalist running to treat PTTD?
This is such a helpful video! My podiatrist diagnosed me with micro tears in my Posterior Tibial Tendons. They have healed quite a bit, but I need to strengthen them further so I can hopefully start running again. I’m looking forward to trying these exercises.
I did not know about this condition and yesterday I did all those exercises in therapy and in the end they put ice on my ankle. I recommend the video 100% because it is what I did in the therapies. Very well explained and the images explain how the exercises should be done.
I have this issue recurring for more than 20 yrs. Specialists told me it was ankle impingements and modifying my jumps greatly reduce the occurrence. However, the injury came back post covid vaccination. I was resuming my jump ropes and felt the tightness on the ankle. It just get worser after each workout despite taking rest days. Now i know that i have been having pttd all this while.
thanks
Thanks for sharing this very useful video. Currently dealing with PTTD... what kind of shoes would u recommend for running? Never had this issue before....until I changed my asics gel kayano to hoka bondi 7 over the winter......
Good day I missed a stair and my ankle rolled in about a month ago bad pain still will try the exercises and hope for good results .I have tried ultrasound and tens machine and ice but still quite bad
Thanks for this informative video! I believe I suffer from this injury due to swelling, tightness and tenderness in this exact area (from a bad ski accident a few weeks ago). I am able to do the single calf raise without pain though, so I'm wondering if it could be something else (calf stretches are very difficult due to tightness though, as well as plantar flexion). Can you do a single leg calf raise without problem and still have PTTD? I went to a sports med doc and ruled out any fractures with an x-ray. I appreciate any thoughts you have.
My son didn't have injuries but was diagnosed young. Since he was young, the surgeon suggested waiting until he is fine growing for surgery & in the meantime west custom orthotics. He is now 21 & determined to join the military. He hopes it doesn't hinder getting accepted but my concern is the nonstop swelling in the ankles, plus the pain he is having learning to run. We just bought some Brooks shoes that is supposed to be good for ankle support. I guess we will see. I hope these exercises will help him.
I'm not a runner but I have severe arthritis in my left ankle. It's due to a triple FX in 1978. I've been to the doctor and he said I may have tendonitis and I also got a cortisone shot which helped for about a month. I'm nearly certain I have tibias poster tendonitis because that is exactly where the pain is located. I'm going to start these exercises and hope it helps. I'm also going to continue to keep roller skating since it's a low impact activity. Good video. Thanks
👍🏼🙌🏼🙂Wonderful Explanation, best in Net and CZcams.....
What a compliment, Mahe! Glad you found this video helpful :)
Can you plz record sth for peroneal tendonitis / tendinosis?
Is this exercises in this video good for it?
Thanks a lot 🤞🏽
I usually skip to the exercises if I'm being honest but this was very interesting. Thank you for sharing
My Hallelujah moment !!!! finding your video. Thank you so much. While I don't get any significant pain while running, the inability to do single leg raises hit the nail on the head. I've now discovered quite a lot of tenderness when pressing the areas mentioned in the video and it explains why my calf was incredibly sore and tight after running. I was already doing tip toe walking and single leg raises but my improvement had stunted.... as I continued to RUN!! , not knowing I was undoing the valuable rehab. I'll now stop running and invest in arch support, feeling very positive about the future been dogged with this problem since Aug 2019. Thank you.
This makes us so happy to hear, Tony! Best of luck with the treatment. Hoping you can finally knock this injury out and crush the rest of 2020 and beyond. Cheers!
We need more high quality videos like this!
Woo! Glad you enjoyed this. Make sure you're subscribed 🤗
@@runnersconnect you are so cute!
Very informative. Good diagrams and explanation of the tendon and what it does, and treatment exercises. The sports medicine professional references are appreciated also.
Glad you enjoyed, Rob. Posterior tib can be a complicated + frustrating injury so we wanted to really hammer it with this video 👍
How soon after you recognize the injury, should you start strength training thank you for the great video
Really like those band exercises
i am not a runner, just an woman in her 60s so a lot of these exercise repetitions may be extravagant. i like your explanations and thoroughness. i started with plantar fasciaitis tightness, then a few weeks of stabbing heel pain and occasional burning pain on inside ankle. this video has been most helpful. i will be seeing a podiatrist and taking your exercises to task. thank you.
Question? i have an arch (which i think i am loosing), but my son is very flat footed, will these help him?
Hi again,
Thank you so much for this video !
So informative !
Unfortunately I have stage 3 foot.
after foot injury 10 years ago.
The tibia started turning outwards last 6 months - that’s were the pain is.(did excercises for 8 months now)
My doctor (here in Sweden) says I can’t have surgery because the ankle is too mobile.
Not many options for foot surgery here in Sweden.
If anybody has any advice -would be much appreciated.
Hello from Singapore 🇸🇬... im flat feet .. never hard feet pain or anything related to pain on my feet.. seen a doc and was told i was having plantar fasciitis.. i was referred to a physiotherapist and was told it wasnt planter fasciitis but a mere muscle sore ..
Couldn't do a heel raise on one foot on days when i finished work .. cuz it is so painful and preventing me from falling asleep. I put ice on the pain to ease it temporary ..
Thankful for this video, i can find alternative stretching exercise and understand about my condition..
I'm developing it after playing in a pickleball tournament. Play was about 3.5 hours almost straight. I've had it before, and it was from playing daily/too much pickleball. So I taped it and will be doing the exercises and lighten up on how much I play.
This video has given me hope, i have this problem for along 1 year and a half, thanks God it hasn´t become worst, but now i´m starting with these recommendations, see you in three months
How'd it go?
I have a boot cast ( for broken Left 5th metatarsal). The cast lifts my Lt foot higher than the Rt. This over pronates Lt foot causing that ( Tibialis) problem with pain hugging the Medial Malleolus. By the way, it ( Posterior Tibialis tendon pain ) can be a very very quick problem. Earlier today I was fine. By 5 PM I could hardly walk. Also , all I did was walk a few steps INSIDE my kitchen ( Cooking) with the BootCast on Lt foot ,and bare footed Rt foot ( thus a huge height difference). Its amazing how quickly the pain came about ( and for seemingly trivial tendon stress).
Will a stability shoe or a most cushioned shoe prevent the shin pain in posterior part?
I have inner knee pain and outer and inner hip pain with PTTD. Also pain in my left hamstrings, behind my left knee, outside of ankle, top of ankle.
I have a high arch but still got the pain in this localized area. I do a lot of sprinting so I figure it is probably from overuse. Hopefully the exercises along with icing help
I have had this for 3 months the Brooks I was told to wear made me much worse . Arch supports don't help me but then without them I hurt worse so I'm at a Loss. Going to PT this next week
How do you get your ankles strong like they were before this happened . I had no accident or Injury
I think I have this. It hurts to push off, and the bone hurts from the sesamoid joint to a cuboid bone. Also, the metatarsal on the outside of the foot also hurts. I have swelling at that ankle more than the left. However, on the right ankle the muscle above the ankle going up toward the shin has generally hurt with some use. Just that leg. I was told I have pronating ankles. I have an orthotics, but they are doing nothing for this issue and my Morton's Neuromas actually feel better with just metatarsal pads in the shoes. I'm not an athlete. This has been going on my whole life with me trying to wear orthotics for the last 6 years. I'll start calf stretching again (I did these my whole life). My arches are still there when I'm not standing on my foot. Also, I regain an arch (not as good on the right foot) when I have Correct Toes on and feel no pain when walking barefoot with these on. My feet are telling me something positive without the orthotics. I've never experienced the intense pain on the bones first mentioned until after I began wearing orthotics.
It seems that I have been experiencing this to a T. I have very high arches but about a year ago I started noticing sharp twinges in my arch, now almost a year later I have inner ankle pain every time I am on my feet. Strangely enough it became worse after buying a new set of running shoes (I guess they weren’t supporting my arch enough). I will give these exercises a try and find some supports on top of that try to shed some excess weight to help alleviate added stress. Thanks so much for the detailed information especially for a person without access to good health insurance!
Hey, Leslie! Thanks for your comment. Not having insurance certainly complicates things. Best of luck and wishing you a speedy recovery!
Thanks for your video very informative!!!Do you have any recommendations for running shoes for individuals with PTTD?
I can't say there's a specific model that's best for this. Unfortunately, it's just a matter of trying on lots of shoes and seeing which ones best support your arch. However, maybe a running shoe store associate will have more insight into this.
Dang, I must have a bad case of it because I can't even walk on it the pain is so bad and I'm on week 3 now. I got it just from walking apparently. Thank you for the information! Will be a while until I can do some stretches.
I’ve been wearing orthotics for the past year and a half and it has kept my foot great!
No doubt orthotics can be super helpful. I like to tell runners - don't hesitate to use orthotics, but make sure they're being used as a tool rather than a bandaid. Ie. they shouldn't be a complete substitute for proper strength training and form improvement 👍
-Coach Michael
Good video, I have just been diagnosed with this problem and had to stop my training. I had a small accident while doing a trail, kicking against a branch with my foot. I kept on running for 20k after that ... should have known better, but I had a race coming. I hope these exercises help.
Man, we've all been there. Thinking "ahh it'll be OK, what's an extra 20k?"
So it goes 🙂
Hope the exercises are helping, David 👍
-Coach Michael
Can you please expand on what the 5 directions are for the balance board?
The study doesn't say. www.bcsorthopedics.com/articles/alvarez-post-tib-dysfunction-managed-with-orthosis%20.pdf
But I guess getting the anle to move in all directions and having the strength to control these motions is what you want to do. So I don't think it matters much as long as you try to go in all directions.
I haven't done this on a balance board, but there is a very similar exercise where you would do a semi squat on one leg by extending the other leg in 5 directions and therefore offsetting the center of gravity. This exercise (I've forgotten it's name) corresponds to tapping the balance board at 12 O'clock, 10, 8, 6, 4 if you're standing on your right foot in the middle of the watch. The last direction is the trickiest one (when done without a board) where you would have to extend the left leg behind you and to the right side as far as possible, kinda like a curtsey.
i have PTTD with flat feet caused by hypomobility. Are these exercises any good for me ? i have to be careful with dislocations
Excellent. The best video on this condition that I've found. Just got diagnosed with this condition and my Doc didn't cover even a mere fraction of the information you have so generously provided here! 👏👏👏👏
Glad it helped!
R u recovered . M in the same boat
i dnt know why i haven't seen this sooner, maybe SEO on ur end
Should I stretch if I still have pain? (Although too little after infested)
This is great. This was referenced on a website about Peroneal Tendon Dysfunction. Even tho the injury is in the opposite (lateral) ankle bone, it is also associated with high arches and is quite rare. The referring website indicated the exercises could be used or adapted for my condition. The things that match are high arches, instability, balance and pain, but pain is on/behind the lateral
(outside) ankle bone. Thank you!
Awesome! Do you mean our video was referenced on another website or just general exercises for this condition? We're glad you could get the information you needed and we wish you a speedy recovery, Mary! :D
Can you clarify the 5 directions for the balance board? Thank you!
Thank you for this excellent video. If this is, in fact, PTTD then I am in between Stage 1 and 2. I've been to a podiatrist whose diagnosis included flat feet, but never mentioned PTTD. Part of the treatment he suggested was wearing Superfeet orthotics and a version of the exercises you show with the Theraband. This condition goes from nothing, through a very low pain to incredibly sore shooting pains through my lift ankle. The pain recedes with ibuprofen. I tend to be on my feet a great deal. Worse still, I fit the category of middle-aged (a bit more than that) and overweight. There's a lot to take care of but I really do not want to be immobilized by this condition. Thanks again for the information.
"Middle-aged, overweight women..." sounds so bleak. These are our rambunctious Mother's!
I was just three weeks into training for Boston when I started getting tibial tendon pain just below inside left angle. So I eased my training from Hal Higdon Advance 1 marathon to novice 1 but tendon pain is still on and off after about mile 2. So I stopped running this week will be seeing a podiatrist. Boston '22 perhaps? Damn.
Sorry to hear you had to cut back, David! However, hope your appointment is useful. Feel free to incorporate these strength routines or ask your podiatrist about them.
Could this cause clicking and clunking when rotating my ankle? What can i do to fix it?
could you do a video on peroneal tendons?
How long does it take to fix the problem of TIBILAIS POSTERIOR?
can you use this treatment whilst the tendon is still inflamed? Just scared I will be causing more damage
I don’t have pain in my tendon but I’d o have flat feet. Will these exercises still help with strengthening my arches?
I had this, and it is debilitating, lasted best part of a year before I found this video. These exercises are very good, really work - definitely the best solution I have found for this injury. Kinesio tape helps too, but just eases the pain, it’s not curing the source
Exactly - any of those solutions (like kinesio tape, compression socks, etc.) will only reduce symptoms, not fix the root of the problem. Great point 👍
Orthotics caused this condition for me in both feet. I now know that the orthotics weakend my posterior tibial muscle and therefore no longer support my PTT. It started out by feeling like my forefoot on both feet was skewing off to the outside when I walked. 36 year old male have always had big calf’s and legs.
I recently starting running a few months ago. I started getting pain 2 days ago while running in snow. Got new shoes today. :-)
Good stuff Kelsea. Snow can add a lot of variables - your lower legs are having to do more stabilizing which can stress the calves (and shins). Having shoes that aren't worn out is a must!!
- Coach Michael
I'm a nurse and I need my feet!!! I hope these exercises help....
I had ankle surgery to replace cartilage in late December. I did my PT diligently but probably started running too soon [even though I continued to wear my ankle brace]. I was very disappointed to then discover the same ankle hurt, but now in a totally different area! It feels like I have PTTD now! I was especially sad when, in the video it says this happens mostly to middle-aged overweight women! UGH! I'm 56 and 123lbs @ 5'4"... maybe not overweight, but definitely carrying more weight than I'm comfortable with! Grrr! Back to PT for me, looks like....
Hey doc I had this for years I even had to stop playing soccer... but last year I discovered that jumping rope and doing exercises on the tampoline really helped and now I can even play soccer in the sand again.. before I could barely walk in the sand.
this make any sense? maybe can help others...
Dear Coach Ruairi, Thankyou so much, this is by far the best video I have ever seen on an ankle/foot injury rehab program. Your anatomy images , your analogies, your well presented exercises are all v thorough and simple to follow and therefore really helpful to me!!
I sprained my ankle 6 months ago while having alot of fun trail running (typical inversion sprain). Most of the swelling has gone but on the opposite side of the ankle around the Posterior Tibial Tendon area there is soreness. If I try to resume training or walk on uneven ground it still feels v sore. I'm trying most of the exercises in this video as it makes sense to build strength in the muscles of the foot. I have decided to use insoles and I've abandoned my zero drop shoes untill I get this injury sorted out.
Where I am still confused is regarding the calf stretching dorsiflexion exercise. I can see it makes complete logical sense and yes every video shows this rehb exercise but it seems to aggravate my injury further. Perhaps its just me, but i'm thinking its best if I avoid it altogether,. Does anyone have any advise about this ?
Many Thanks
So glad you enjoyed this video and more importantly found it helpful! Sounds like taking a break from the zero-drop shoes is best for now.
No individual's symptoms will be exactly the same as another runner. If you have given it a shot, but it's not bringing relief then just scratch that exercise from the routine. 👍