Activities that cause or worsen the pain should be avoided. Low-impact exercises can help to maintain overall health without affecting the tendon. These include bicycling, elliptical training, and swimming.
Cryotherapy or cold therapy can be applied on the most painful area of the posterior tibial tendon for 20 minutes, 3 or 4 times a day to reduce the swelling. It should not be applied directly to the affected part. Place ice over the tendon immediately after completing an exercise, this helps to decrease the swelling around the tendon.
Cast or boot:
A leg cast or walking boot may be used for a few weeks. This allows the tendon to rest and the swelling decreases.
Orthotics and braces can also be recommended. An orthotic is a shoe insert used for the treatment of a flatfoot. A custom orthotic is required in patients who have moderate to severe changes in the foot. An ankle brace may be used in case of mild to moderate flatfoot. The brace supports the joints of the back of the foot and takes the tension off the tendon. A custom-molded leather brace is recommended for severe flatfoot that is stiff or arthritic. Brace also helps some patients to avoid surgery.
Transcutaneous electrical stimulation (TENS):
Transcutaneous electrical stimulation (TENS) is an electrical modality that can be used to control pain and swelling.
Therapeutic ultrasound can stimulate cell migration, proliferation, and collagen synthesis of tendon cells which can benefit the healing process.
Shockwave therapy is an innovative approach for treating posterior tibialis tendon dysfunction, as proved by various research studies.
Manual therapy uses hands to help improve the ankle moves after posterior tibialis tendon dysfunction (PTTD). After immobilization, the joints of the ankle and toes may be stiff, and thus joint mobilizations may be necessary to improve overall mobility.
Range of motion exercises:
Ankle ROM exercises include pulling the toes and ankle up, pointing the toes and ankle down, moving the foot and ankle inwards, and moving the foot and ankle to the side and away from the body (eversion), these exercises for PTT dysfunction should not hurt.
Calf stretches while standing are a great way to stretch the tendon and the muscles surrounding it. A foam roller can also be used to loosen the calf muscles.
Ankle strengthening exercises add stability to the foot and ankle. This takes the stress and strain from the injured posterior tibialis tendon. Strengthening the ankles with resistance bands is an easy way. Wrap the band around the foot to create resistance while moving the foot. Few exercises that can be done with resistance bands are ankle inversion, ankle eversion, ankle dorsiflexion, and ankle plantarflexion. These exercises should not hurt but should make the ankle and foot feel a little tired. Strengthening the muscles in the hips and knees helps make sure that the foot is in the correct position while moving. Strengthening exercises include squats, lunges, straight leg raises, single-limb heel raises, resistance band exercises, and walking on the toes over a short distance to help prevent injuries.
Balance and proprioception exercises:
Balance and proprioception exercises are a part of a physiotherapy program. Proprioception is the ability to figure out where the body is and how it's moving. Better balance and awareness of the position of the foot and ankle can decrease the stress on the injured tendon. Balance exercises like a single-leg stance progression, standing on a foam pad with one foot and catching a ball, standing on the pad, and squatting down slowly, can be done. Tools like BOSU balls, wobble board, and BAPS board can be used.
Gait training helps to restore normal walking, so gait training may be done during the physiotherapy sessions. The therapist performs specific exercises to help improve the way the patient walks. Assistive devices should also be used so that the progress is proper and safe.
Plyometrics are exercises that use the body's ability to jump and land with explosive power. They enable run quickly, change direction, and take the forces on the body while running and jumping. Plyometric exercise can be used as a part of posterior tibial tendon dysfunction rehab. Examples of plyometric exercises are drop jumping, hopping, or jumping in different planes of motion and directions.