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Preventing Posterior Tibialis Dysfunction

Recently, I asked our Precision family what they wanted to learn more about. I was

asked to discuss how to prevent overuse of the posterior tibialis, so here we go!

What is the posterior tibialis?

The posterior tibialis is a muscle in the foot and ankle. The muscle and tendon

originate from the posterior (backside) aspect of the tibia, fibula and interosseous

membrane (under the calf muscle). It descends between flexor hallucis longus and

flexor digitorum longus, and then courses under the foot to split and insert into the

navicular bone, the base of the second through fourth metatarsals and second

cuniform bone.

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The primary job of the posterior tibialis is to maintain the arch of the foot and to

help to supinate (create a ridged lever), adduct and plantar flexion (point) the foot.

It is also the main inverter of the foot.

Why does this matter to runners?

As runners, we often only pay attention to things when they begin hurting. However,

posterior tibial tendon dysfunction, such as elongation of the tendon and

tendionosis, often begins before symptoms occur. The posterior tibialis is the

primary dynamic stabilizer of the foot, and abnormal foot mechanics, such as over

pronation, can lead to a flatfoot, pain, tendonopathy and possible rupture.

Recovering from an injury in the foot or ankle can take a long time and may even

prevent you from running, so avoiding this altogether is the best option.

What can I do to prevent posterior tibialis injury?

1. Avoid overtraining: This sounds simple, but training error is the number one

reason we get injured in the first place. If you are just starting out as a runner

or if you have been one for 50+ years, meeting with a running coach is very

beneficial. Believe me, a good coach knows more than you do. I promise. A

coach can help you build a training plan that fits into your lifestyle and allows

you to reach your goals without fatiguing and breaking down your body

along the way. Despite what you may think, most running coaches are not

expensive, and having one will probably save on your medical bills later.

2. Walk around barefoot and use the intrinsic muscles of the foot: If you never

use the muscles in your foot, they will not be strong. Exercises like toe yoga

and arch domers are often overlooked but can create a stabile base of

support for you to run on. Once you can do these exercises, start combining

them with other more functional exercises.

3. Hip strength: Yes, I said it, the glutes and other hip muscles can and do affect

the foot position. If you have weakness in the hips with single leg activities,

then every time your foot hits the ground you are increasing the stress on the

posterior tibialis. The posterior tibialis eccentrically controls pronation and

maintains the arch. If your hips are dropping every step you take the

posterior tib has to absorb the additional force at the foot/ankle.

4. Shoes and orthotics: If you are not having pain in the foot and ankle, then I

would not suggest an orthotic or more stable shoe. I would say work on your

strength in the foot/ankle and hip musculature. However, if you are having

foot pain already you may need a more supportive shoe or orthotic

(Superfeet are great off the shelf orthotics) to temporarily offload the foot so

they you can improve its strength and decrease the stress.

There is no magic pill to avoid injury. It is all about being smart. Overtraining and

working out when you are exhausted, too stressed out or sick all can lead to injury.

If you are taking care of yourself, you are less likely to be injured. Strength training,

dynamic warm ups and cross training also improve your chances of staying injury


Dr. Kate Mihevc Edwards is a board certified orthopedic specialist, a specialist is running and endurance medicine and the owner/CEO of Precision Performance & Physical Therapy.


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