Posterior tibial tendonitis physical therapy in Carmel, Indiana

The posterior tibial tendon connects a deep calf muscle to the bones of the inner midfoot, mainly the navicular, and it is one of the main structures that hold up the arch and lock the foot rigid for push-off. When it is overloaded faster than it adapts, it becomes painful and weaker, a problem usually called tendinopathy rather than true inflammation.

It most often develops gradually in adults, commonly from middle age onward, and it is more frequent in women. Risk rises with a naturally flatter foot, higher body weight, diabetes, high blood pressure, previous steroid injections near the tendon, and a sudden jump in walking, standing or running. A new job on concrete floors or a summer of long walks on the Monon Trail can tip a borderline tendon over.

The reason clinicians take it seriously is what happens if it is ignored. As the tendon weakens, the arch can gradually flatten and the heel can drift outward. In late stages the foot stiffens in that position. Early care aims to stop that progression while the foot is still flexible.

Treatment pairs short-term support that takes strain off the tendon with a progressive strength program that rebuilds it. For a painful, irritable tendon, that support might be an over-the-counter arch support, a custom orthotic from a podiatrist, a supportive shoe or, for a few weeks, a walking boot or ankle brace prescribed by a physician.

Loading starts with exercises the tendon tolerates, often seated or banded foot inversion and gentle isometric holds, then progresses to double-leg and single-leg heel raises with the heel kept turned inward, holding a ball between the heels, and weighted calf raises. The banded ankle inversion exercise shows one early step, and the short foot exercise trains the small arch muscles that share the work.

Sessions in a private suite allow the calf and hip work to go well beyond band strength, using a rack, dumbbells and a step. Hip strength matters because a knee that drops inward pushes the foot into a flatter position. Walking volume is managed as well, with a plan to build back to longer walks or runs once single-leg heel raises are strong and comfortable.

• Pain-guided inversion and isometric tendon loading
• Progressive heel raises with the heel kept turned inward
• Calf flexibility and strength
• Intrinsic foot and hip strengthening
• Footwear and arch support decisions
• A graded return to longer walks, hikes or runs

The quickest change is to reduce how much the tendon is being stretched and loaded each day. Wear supportive shoes rather than flat, flexible ones, including around the house if you are on your feet a lot, cut back on long walks and hills for now, and avoid going barefoot on hard floors.

Start gentle tendon work: seated foot inversion against a band and slow heel raises on two feet, both kept in a comfortable range. Mild discomfort that settles within a day is acceptable; sharp pain or pain that keeps building is a signal to ease off. Pain behind the inner ankle that is new after a twist, with a sudden drop in the arch, needs a physician quickly.

If your arch is changing or the pain has lasted more than a few weeks, complete the foot and ankle questionnaire. The matching team proposes a therapist in the network with an orthopedic focus, and you can read about that approach on the orthopedic physical therapy page.