Posterior tibial tendon: returning to sport step by step

Why it happens

Flat foot or marked pronation, increase in volume, worn shoes, uneven surfaces.

Coming back in four stages

1. 1

   Short flat walks with stable shoes, according to your healthcare professional’s advice.

2. 2

   Calf and foot strengthening prescribed or approved by your physiotherapist, possibly insoles.

3. 3

   Alternating walking and running on flat ground, without camber or uneven terrain.

4. 4

   Easy continuous running, then varied terrain and speed gradually.

Move on to the next stage after 2 sessions in a row with discomfort of 2 out of 10 or less and no pain the next day. Each stage usually lasts 1 to 2 weeks, depending on your healthcare professional’s advice. For the tibialis posterior, rising onto the toes of the injured foot the next day must remain possible and pain-free on the inside of the ankle.

Movements to postpone

• sauts from stage 4
• côtes et descentes from stage 4

Strengthening exercises

• Ankle inversion with band

  from stage 1 of the plan

  Seated, band around the forefoot, turn the sole inwards slowly then return over 3 seconds.

  To start: 3 sets of 15, slowly, once a day.

  Variations, mistakes and progression

  Easier

  No band, or a very light band.

  Harder

  Stronger band, with a 2-second pause at the end.

  Common mistakes

  • Turning the knee instead of the foot.
  • Letting the band snap back.

  Moving on

  When 3 × 20 is easy with the strongest band.

• Short-foot exercise

  from stage 1 of the plan

  Seated or standing, draw the ball of the foot towards the heel without curling the toes, as if doming the arch. Hold 5 seconds.

  To start: 10 contractions of 5 seconds, twice a day.

  Variations, mistakes and progression

  Easier

  Seated, foot resting without body weight.

  Harder

  Standing on one foot, then balancing while keeping the arch lifted.

  Common mistakes

  • Curling the toes instead of shortening the foot.
  • Lifting the heel.

  Moving on

  When you can keep the arch lifted for 10 seconds standing on one foot.

• Heel raises

  from stage 2 of the plan

  Standing, rise on both feet and lower slowly over 3 seconds. Keep the knee straight, then bent to work the other part of the calf.

  To start: 3 sets of 12, 3 seconds down, every other day.

  Variations, mistakes and progression

  Easier

  Seated on a chair, a light weight on your knees.

  Harder

  Heels over the edge of a step, to go lower.

  Common mistakes

  • Bouncing at the bottom instead of controlling the way down.
  • Rising higher on one side than the other.

  Moving on

  When 3 × 15 is easy with no discomfort the next day: move on to single-leg raises.

• Single-leg balance

  from stage 2 of the plan

  Stand 30 seconds on one foot, knee slightly bent. Then with eyes closed, then on a cushion or unstable surface.

  To start: 3 holds of 30 seconds per leg, every day.

  Variations, mistakes and progression

  Easier

  One hand on a chair, or the tip of the free foot on the floor.

  Harder

  Eyes closed, then on a cushion, then throwing a ball against a wall.

  Common mistakes

  • Knee straight and locked.
  • Looking at your feet instead of a point ahead.

  Moving on

  When you can hold 30 seconds without putting the other foot down, as on the healthy side.

• Single-leg heel raises

  from stage 3 of the plan

  Same movement on one foot, lowering over 3 seconds, a light hand on a wall if needed. Add a loaded backpack very gradually.

  To start: 3 sets of 8 to 10 per leg, 3 seconds down, every other day.

  Variations, mistakes and progression

  Easier

  Rise on both feet and lower on one.

  Harder

  On a step with the heel over the edge, then with a loaded backpack.

  Common mistakes

  • Leaning too much on the wall.
  • Bending the knee to cheat on height.

  Moving on

  When you can do 20 to 25 raises in a row on the injured leg, roughly as many as on the other.

The doses are starting points. Stay at 2 out of 10 discomfort at most, during and the next day; otherwise switch to the easier version or go back to the previous exercise.

Rehab’s advice

Stable shoes, flat ground, no cambered surfaces at first. Have your foot support assessed by a physiotherapist or podiatrist.

What the Rehab plan does for this injury

The plan starts at 30% of your previous training volume and builds up to 80%, with a consolidation week every three weeks. If your discomfort reaches 5 out of 10, it stops and refers you to your doctor or physiotherapist.