PTTD Exercises: A Physical Therapist’s Guide to Strengthening Your Foot

If you’re dealing with posterior tibial tendon dysfunction, you might feel like your options are limited—either rest completely or risk making things worse. The good news is that’s not true. Targeted exercises, when done correctly, can actually help strengthen the posterior tibial tendon and support your arch. The key is knowing which exercises to do and how to do them safely.

Why exercise matters for PTTD

Your posterior tibial tendon isn’t just any tendon—it’s the main support structure for your medial arch. When this tendon becomes overloaded or weakened, the arch collapses, and things like walking and standing become painful. But tendons are living tissue. They respond to controlled stress by getting stronger, just like muscles do.

The trick is progressive loading: applying just enough challenge to stimulate adaptation without overwhelming the tendon enough to cause more damage. Research on tendon healing suggests that eccentric loading—exercises where the muscle lengthens under tension—can be particularly helpful for tendon recovery.

Stretching exercises for PTTD

Tightness in your calf muscles and Achilles tendon can actually make PTTD worse. When your calf is tight, your foot overpronates more with each step, putting extra stress on the posterior tibial tendon. Stretching these areas takes pressure off the tendon and helps your foot function better.

Calf stretches

Standing calf stretch is simple but effective. Stand facing a wall, place your hands on it for balance, and step your affected foot back about a foot’s length. Keep your back heel on the ground and lean forward gently until you feel a stretch in your calf. Hold for 30 seconds and repeat 3 times. Do this multiple times throughout the day.

For a deeper stretch, try the downward dog yoga pose—it stretches both your calves and your hamstrings simultaneously. If you’re new to yoga, start slowly and only go as far as feels comfortable.

Achilles tendon stretch

Your Achilles tendon connects to your calf muscles, so stretching one affects the other. Using a resistance band or towel, sit with your leg extended in front of you and gently pull your toes toward you. You’ll feel the stretch along the back of your lower leg. Hold for 30 seconds and repeat several times daily.

Strengthening exercises for PTTD

Once you’ve established some flexibility, it’s time to build strength. These exercises target the muscles that support your arch.

Toe curls and marble pickups

These might seem too simple to matter, but they work the intrinsic muscles of your foot—the small muscles that help control arch stability. For toe curls, place a towel on the floor and use your toes to scrunch it toward you. For marble pickups, place marbles on the floor and pick them up one at a time using only your toes, dropping them in a cup. These exercises improve the dynamic support your foot provides while walking.

Heel raises

Standing heel raises directly strengthen your posterior tibial tendon and the muscles that support your arch. Stand behind a chair or near a wall for balance. Rise up onto your toes, hold for 2-3 seconds, then slowly lower back down. Start with 10 repetitions and work up to 15-20. As you get stronger, try doing heel raises on just one leg—but only if your pain allows.

Resistance band inversion

This exercise targets the tibialis posterior muscle directly. Sit with your leg extended and wrap a resistance band around your foot, anchoring the other end to a sturdy object. Turn your foot inward against the band’s resistance, then slowly return to the starting position. Start with light resistance and gradually increase as your strength improves.

Balance and proprioception exercises

Your foot’s ability to sense its position in space—called proprioception—is crucial for proper mechanics. When this sense is impaired, your foot is more likely to overpronate, worsening PTTD.

Single-leg standing

Stand near a wall or counter for safety. Lift your unaffected leg and try to balance on your affected leg alone. Start with 30 seconds and work up to a minute. Once that becomes easy, try it with your eyes closed or while slightly moving your head.

Balance board exercises

If you have access to a wobble board or balance disc, these tools challenge your proprioception in a controlled way. Start by simply standing on the board with both feet, shifting your weight gently side to side. Progress to single-leg standing as your balance improves.

Tips and precautions

The most important rule with PTTD exercises is to start slowly. If you experience pain during or after exercise that’s worse than your baseline symptoms, back off. Some muscle soreness is normal, but sharp or aching pain that persists isn’t.

Consistency matters more than intensity. Doing gentle exercises every day is far better than doing intense exercises once a week. Think of it as building a habit, not training for a competition.

Pay attention to your footwear too. Supportive shoes with good arch support complement your exercise routine. If you’re exercising in bare feet on hard floors, consider adding a mat for cushioning.

When to see a physical therapist

While home exercises can be helpful, working with a physical therapist has advantages. A PT can assess your specific situation, ensure you’re doing exercises with proper form, and create a progressive program tailored to your stage of PTTD. If you’re unsure where to start, or if your symptoms haven’t improved after a few weeks of home exercises, consider scheduling an evaluation.

Some people with PTTD also have significant biomechanical issues that may benefit from custom orthotics. A podiatrist or sports medicine doctor can evaluate whether orthotics would help support your treatment plan.

Sources

  • American Academy of Orthopaedic Surgeons (AAOS) - PTTD overview and treatment guidelines
  • Journal of Foot and Ankle Research - tendon loading and rehabilitation protocols
  • Physical Therapy for PTTD clinical resources

This article is for informational purposes only and is not a substitute for professional medical advice. Always consult with a healthcare provider before starting any exercise program.