By MISSY ALBRECHT, DPT, CSCS, FMS| Physical Therapist/Coach
Muscle Spotlight: Posterior Tibialis
This muscle originates on the posterior surface of the tibia and fibula, which are your two lower leg bones. The muscle then runs down the back of your lower leg, behind the medial bone of your ankle, and attaches to the bottom of many bones in your feet (see image for details).
**Usually your lower leg is termed the calf, but there are other muscles in the lower leg that lie deeper than the “calf,” which is a combination of the gastrocnemius and soleus muscles.
This muscle causes plantar flexion and inversion of your ankle (see video below for a visual of these movements). It also helps create the arch of your foot, along with many other structures, so it needs to be strong to support one’s body weight.
When your posterior tibialis becomes problematic….
What does this muscle have to do with people who lift heavy weights like all of you? A lot! Especially if you’re wearing the barefoot shoes, so read on…
This muscle can be a common site of inflammation, leading to long-term tendon damage if not treated (i.e. tenodonitis, -osis and/or -opathy). Because of its location in the arch of the foot, the muscle/tendon needs to be strong and be able to support our body weight. The problem usually doesn’t stem from this muscle originally, but from some other alteration in the foot and/or ankle joint. For example, limited ankle flexibility (dorsiflexion) may be caused by an old ankle sprain. This causes the foot to have to turn out more, which then causes the arch to collapse. With every collapse, the posterior tibialis tendon is overstretched and weakened, eventually causing little tears in the tendon. This can cause pain and eventually the image below….
A Quick Self-Assessment
Everyone take a look at how you stand naturally with your shoes off. Do you have one arch that’s flatter than the other? Do you turn this foot out more when you squat, walk, or run? Do you sometimes get “shin splints” on the medial/posterior side of your shin? Or pain in your arch? Maybe a hammer toe forming on that foot?? If yes, you may have some stage of this tendonopathy. The reason you want to take care of it is because the tendon can eventually rupture, leading to long-term consequences and possibly surgery. The foot is a very complicated and detailed area of the body, so if you really have pain, make sure you get it checked out by a medical professional. This info is just a generalized summary of how tendonosis of this muscle can present.
What should you do to prevent further damage?
1. Orthotics may be a temporary solution!
I thought I’d get this one out of the way because there is so much debate about it. If the tendon is highly inflamed, pressure needs to be relieved in order for it to heal. The orthotic will give your arch just enough support to relieve pain and let the tendon heal. Then you can start to add in arch strengthening to help wean you away from the orthotics. If you already have some bad damage to the arch of either of your feet, this is when barefoot shoes may not be your best friend. LISTEN TO YOUR BODY.
2. Make sure you have good ankle flexibility.
This will keep your ankle happy overall and decrease stress on other areas. If one area is stiff, other areas must compensate and work harder than they should to make up for it.
3. Decrease the time you spend in flip flops.
The constant grabbing of your toes to keep the shoes on puts extra stress on your foot and creates more problems in the long run.
4. Get into the posterior tibialis with the lacrosse ball.
You will most likely need to put the ball on the yoga block or a book to get more pressure. Go all the way along the medial side of your shin bone, moving your ankle around as you work through tight spots.
5. Strengthen your arch!
The video below has a great exercise towards the end. I would even recommend everyone do this exercise as a transition into barefoot shoes because these muscles probably haven’t been working much while wearing extremely supportive shoes.