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Tibialis Posterior Strengthening | Flat Feet Exercises & Treatment

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Tibialis posterior strengthening

Tibialis Posterior Strengthening | Flat Feet Exercises & Treatment

The tibialis posterior is an essential stabilizer of the foot during standing and walking. The tibialis posterior tendon provides dynamic support along the plantar aspect of the foot and arch and when the muscle or tendon is deficient, decreases in longitudinal arch height often occur and can lead to flat feet.

For this reason, tibialis posterior strengthening is recommended next to foot orthoses in the rehabilitation of painful pes planus to prevent tibialis posterior tendon dysfunction and foot arch collapse. But how can we strengthen this muscle ideally? Kulig et al. did an MRI study to determine which exercise most selectively and effectively activates the tibialis posterior. They found the greatest isolated activation with the following exercise:

Have your patients sit on the bench with his knees about a full arm’s length apart and flexed about 80°. Then the patient is asked to stabilize his leg by placing the contralateral forearm between the knees and reinforcing it with the ipsilateral hand. Then an elastic band is looped around the medial and distal part of the foot that is to be trained and stretched to full tension while maintaining an inclination angle of 45 degrees . While the examiner ensures tension throughout the whole movement, the patient is asked to slide his forefoot into adduction from full abduction with the foot remaining in contact with the floor. The total range of motion can be marked with a tape to ensure full range of motion with every repetition.

In 2005 Kulig et al. compared the activation of the tibialis posterior in patients with flat feet and found higher selective activation in those patients when wearing foot orthoses and shoes. As this is the patient group you would want to give this exercise to wearing insoles and footwear is recommended.

Progression can be adjusted based on the tension of the theraband by the examiner or by choosing a theraband with a higher resistance. Like with any other rehabilitation program the total volume of the exercise should be slowly increased over time. Kulig et al.were able to decrease pain and increase function in their third study in 2009 after a 10-week program with 3 sets of 15 repetitions twice per day.

If you want to learn how to assess for forefoot over-pronation check out our post on the navicular drop test.


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Kulig K, Burnfield JM, Requejo SM, Sperry M, Terk M. Selective activation of tibialis posterior: evaluation by magnetic resonance imaging. Medicine and science in sports and exercise. 2004 May 1;36(5):862-7.

Kulig K, Burnfield JM, Reischl S, Requejo SM, Blanco CE, Thordarson DB. Effect of foot orthoses on tibialis posterior activation in persons with pes planus. Medicine and science in sports and exercise. 2005 Jan 1;37(1):24-9.

Kulig K, Lederhaus ES, Reischl S, Arya S, Bashford G. Effect of eccentric exercise program for early tibialis posterior tendinopathy. Foot & ankle international. 2009 Sep;30(9):877-85.



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