Effective Management of Posterior Tibialis Tendonitis for Runners

Effective Management of Posterior Tibialis Tendonitis for Runners

Runners often face various injuries, with posterior tibialis tendonitis being one that can significantly impact performance due to its crucial role in foot mechanics. This condition, characterized by inflammation or overuse of the posterior tibialis tendon, leads to pain along the inner side of the foot and ankle, potentially affecting the foot’s arch. Drawing upon recent studies and specific exercises, we aim to provide a comprehensive overview of this condition, focusing on effective management and prevention strategies for runners.

Understanding Posterior Tibialis Tendonitis

The posterior tibialis tendon plays a pivotal role in supporting the foot’s arch and enabling efficient gait. Tendonitis in this tendon can result from overuse, improper footwear, or biomechanical imbalances, such as overpronation. Symptoms include pain, swelling, and in severe cases, a flattening of the foot’s arch.

Diagnosis and Conservative Treatment Approaches

Early diagnosis is key to managing posterior tibialis tendonitis effectively. Conservative treatment often includes rest, ice, physical therapy, and in some cases, orthotic devices to correct biomechanical issues. A study by Howitt et al. highlights the success of conservative treatments, including specific exercises to strengthen the posterior tibialis tendon and improve foot mechanics​​. Check out our other article on posterior tibial tendonitis

Targeted Exercises for Rehabilitation

Heel-Ups with Tennis Ball: This exercise is designed to strengthen the posterior tibialis tendon. The patient performs heel-ups while squeezing a tennis ball between the medial malleoli (the bony prominences on the inner side of each ankle). This action encourages targeted strengthening of the tendon and supports the arch​​.

Effective Management of Posterior Tibialis Tendonitis for Runners

Incorporating Strengthening Exercises into Your Routine

For runners, incorporating specific exercises into their training regimen can be instrumental in preventing posterior tibialis tendonitis. The “Heel-Ups with Tennis Ball” exercise is particularly beneficial as it directly targets the posterior tibialis tendon, promoting strength and stability in the foot’s arch. Including this exercise in your routine can help maintain tendon health and prevent the onset of tendonitis.

Additional Preventive Measures

  • Proper Footwear: Choosing shoes with adequate support and cushioning to address biomechanical issues such as overpronation.
  • Gradual Training Progressions: Increasing mileage and intensity gradually to avoid overuse.
  • Cross-Training: Engaging in low-impact exercises to reduce stress on the feet and ankles.
  • Flexibility and Strength Training: Focusing on overall lower leg strength and flexibility to support the foot’s arch and improve gait mechanics.


Posterior tibialis tendonitis can be a challenging condition for runners, but with early diagnosis, targeted exercises, and appropriate preventive measures, it is manageable. Incorporating exercises like “Heel-Ups with Tennis Ball” into your training, alongside adopting measures to correct biomechanical imbalances, can significantly reduce the risk of tendonitis and keep you running strong and healthy.

For runners experiencing persistent pain or symptoms indicative of posterior tibialis tendonitis, consulting with a healthcare provider or a physical therapist specialized in sports injuries is crucial. Tailored exercises and treatment plans can address specific needs, ensuring a successful recovery and return to running.

Remember, taking proactive steps to strengthen and protect your posterior tibialis tendon is key to maintaining foot health and achieving your running goals.

FAQs on Posterior Tibialis Tendonitis

Q1: What is Posterior Tibialis Tendonitis?

It’s an overuse injury affecting the tendon that supports the foot’s arch. Symptoms include pain along the inner ankle and foot, swelling, and in severe cases, a flattening of the arch.

Q2: What causes this condition in runners?

Causes include overuse, improper footwear, biomechanical issues like overpronation, and sudden increases in running intensity without adequate adaptation.

3: How is Posterior Tibialis Tendonitis diagnosed?

Diagnosis typically involves a physical examination by a healthcare professional, sometimes supplemented with imaging tests like MRI or ultrasound to assess the extent of the injury.

4: Can I still run with Posterior Tibialis Tendonitis?

Running with Posterior Tibialis Tendonitis is not advised as it can exacerbate the condition. Rehabilitation and a gradual return to running under professional guidance, is recommended.

5: How can I prevent Posterior Tibialis Tendonitis?

Prevention strategies include wearing proper footwear, incorporating strength and flexibility exercises for the lower leg and foot, and gradually increasing running distances to avoid overuse.



Howitt et al. – Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report. Journal of the Canadian Chiropractic Association.

“Effectiveness of Physical Therapy for Improving Posterior Tibialis Function.” Journal of Physical Therapy Science.

“Conservative treatment for posterior tibial tendon dysfunction.” PubMed.


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Dr. Matthew Perry

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