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.
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.
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if i may give one suggestion that is maybe hard to implement. but i sometimes struggle with explaining things in patient language. so maybe add some frequent asked questions / mechanisms from patients and how to explain it simple or with a metaphore ?
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Curso Magnifico!!!, honestamente, es la universidad del futuro, aprenderá todas las patologías comunes del cuerpo con un solo clic: epidemiología, factores pronósticos, curso, evaluación y tratamiento, todo desde un punto de vista científico. Bien estructurado, fácil de leer, navegación rápida, videos de alta calidad. Podrás responder a tu paciente cuánto tiempo durarán sus molestias basado en la última evidencia con los números adecuados, lo que les dará un pronóstico justo que los ayudará a mantenerlos motivados para la terapia y ser pacientes y constantes. No hay un día en el que no lo use en la práctica para consultar una test específico o la sensibilidad de este. Incluso se obtienen puntos de acreditación, un monton ellos en comparación con otros cursos que luego nunca usas en su rutina diaria. 100% recomendable!!Nathan28/05/19Orthopedic Physiotherapy of the Upper and Lower Extremities A great course for new grads! I have found this course to be very well put together. Firstly the formatting is very user friendly – it’s easy to work through but also very to easy to navigate to specific sections to use as a reference resource. As always with these guys the videos are very high quality. The attention to detail with academic references is also spot on. You can be assured that the info is evidence based. Overall, highly recommended.Stijn14/02/19GREAT COURSE I thinks this course is great, I find the framework it teaches you very useful in assessing my patients. I like how the different pathologies are very clearly explained from epidemiology to pathophysiology to diagnostics to treatment, all evidence based. The Physiotutors-style videos used to explain the subject matter are really useful for studying too. Finally, the assingments at the end of the chapters are a great way to test and practice your knowledge on the subject you just studied.
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The course consists of easily understandable bite sized lessons. This way it was easy to spend a little time every day to work on this course. All information is easily to find and it is not too much information to remember. It really helped me as a starting physio to get more structure and confidence in my intakes and testing procedures.
Sometimes there are some grammatical or spelling mistakes, but those don’t bother me. Sometimes it would have been nice to maybe have had a bit more information on treatments though.
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Such an informative course, covers everything a physio requires! Would be better if they offered a printed material! Had a hard time with reviewing due to availability solely on e version.