Exercise is one of the most powerful tools you have against PTTD—especially in the early stages. But not all exercises help. Some can actually make things worse.
This guide walks you through evidence-based exercises that strengthen the muscles and tendons supporting your arch.
Important: If you're in Stage 3 or 4, exercise alone won't fix the problem. See a professional. These exercises help most in Stages 1-2.
The Key Muscle: Tibialis Posterior
Before we get to exercises, you need to meet the star player: the tibialis posterior.
This muscle:
- Runs along the back of your lower leg
- Tendon attaches along the inside of your foot
- Does the heavy lifting for arch support
- Inverts your foot (turns it inward)
- Plantarflexes your ankle (points toes down)
When this muscle/tendon is weak, your arch collapses. Strengthening it is the foundation of PTTD rehabilitation.
Exercise Principles for PTTD
Before starting any exercise program:
- Start slow — If it causes pain, stop
- Progress gradually — More reps, more resistance over time
- Be consistent — Daily is better than occasional
- Quality over quantity — Perfect form beats many sloppy reps
- Listen to your body — Some muscle fatigue is normal; sharp pain is not
The Exercises
1. Tibialis Posterior Strengthening (Inversion)
What it works: The main muscle you need to strengthen.
How to do it:
- Sit with your leg extended, or lie on your side
- Loop a resistance band around your foot (or use a therapy band)
- Anchor the other end to something stable—or have someone hold it
- Turn your foot inward (invert) against the resistance
- Slowly return to start
- Repeat
Reps: 10-15 reps × 2-3 sets, daily
Progress: Once this is easy, increase resistance (stronger band).
Safety: Pain along the tendon is common initially. Sharp pain or increasing weakness is not normal—ease off.
2. Toe Yoga
What it works: Intrinsic foot muscles that support your arch.
How to do it:
- Sit or stand with feet flat on the floor
- Try to lift just your big toe while keeping your other toes down
- Then try to lower just your big toe while lifting the other toes
- Practice until you can do each independently
Reps: 10 reps of each movement, daily
Why it helps: These small muscles work with the tibialis posterior to maintain arch integrity. Most people with PTTD have weak intrinsics.
3. Short Foot Exercise
What it works: Intrinsics and engages the tibialis posterior.
How to do it:
- Sit or stand with feet flat
- Imagine you're trying to pick up a marble with your toes
- Or: push your big toe into the floor while pulling your other toes toward your heel
- You should feel a contraction along your arch
- Hold for 5 seconds, release, repeat
Reps: 10 reps × 2-3 sets, daily
Tip: Don't scrunch your toes—shorten the foot by lifting the arch.
4. Heel Raises (Calf Raises)
What it works: Calf muscles, but also engages the tibialis posterior when done correctly.
How to do it:
- Stand behind a chair or near a wall for balance
- Rise up onto your toes
- Lower slowly back down
- For more tibialis posterior activation: do them with your feet turned slightly inward (pigeon-toed)
Reps: 10-15 reps × 2-3 sets, daily
Progress: Once bodyweight is easy, do single-leg raises.
Warning: If you have significant flatfoot, some people find heel raises aggravate their PTTD. If it hurts, skip this one.
5. Eccentric Calf Stretches
What it works: Flexibility, and the controlled lowering actually strengthens.
How to do it:
- Stand on a step or curb on your toes
- Slowly lower your heels down below the step level
- Use both legs initially, then progress to one
- Slowly rise back up
Reps: 10 reps × 2 sets, daily
Why it helps: Tight calves increase stress on the PTT. Stretching them improves mechanics.
6. Towel Scrunches
What it works: Intrinsic foot muscles.
How to do it:
- Sit with your foot flat on a towel on the floor
- Scrunch the towel toward you using only your toes
- Then use your toes to spread the towel back out
Reps: 10-15 reps, daily
Tip: Imagine your toes are fingers picking something up.
7. Balance Exercises
What it works: Proprioception and Tibialis posterior endurance.
How to do it:
- Stand near a wall for safety
- Lift one foot
- Balance on one leg for 30-60 seconds
- Progress: close your eyes, stand on a cushion
Reps: 3-5 reps each side, daily
Why it helps: PTTD affects balance. Training it improves foot control.
Exercise Order: Where to Start
If you're new to this, here's a sensible progression:
Week 1-2:
- Toe yoga
- Short foot exercise
- Towel scrunches
- (Gentle) balance
Week 3-4:
- Add tibialis posterior inversion with resistance band
- Start eccentric calf stretches
Week 5+:
- Add heel raises (if tolerated)
- Progress balance exercises
What to Avoid
Some commonly recommended exercises actually make PTTD worse:
| Exercise | Why Avoid |
|---|---|
| Traditional Toe Curls | Can overwork the wrong muscles |
| High-impact jumping | Too much stress on the tendon |
| Running (during recovery) | Aggravates inflammation |
| Deep squats | Loads the ankle heavily |
| Any exercise that causes sharp tendon pain | You're making it worse |
When to See a Professional
These exercises help in Stages 1-2. But you should see a professional if:
- Pain is getting worse despite exercises
- You're in Stage 3 or 4
- You can't do these exercises without significant pain
- You want a personalized program
- You're considering returning to sports
A physical therapist specializing in foot biomechanics can:
- Assess your specific weakness
- Design a program tailored to you
- Progress you appropriately
- Manual therapy to improve mobility
How Long Until You See Results?
Be patient:
- Weeks 1-2: Might feel awkward, some mild soreness
- Weeks 3-4: Starting to feel easier, less fatigue
- Months 2-3: Noticeable improvement in strength and pain
- Ongoing: Maintenance prevents regression
Consistency matters more than intensity. 10 minutes daily beats an hour once a week.
Complementary Approaches
Exercise works best alongside:
- Proper footwear — Supportive shoes protect what you're building
- Orthotics — Reduce tendon stress while you strengthen
- Weight management — Less load on the tendon
- Activity modification — Don't undo your hard work with aggravating activities
Putting It All Together
Start today with just these three:
- Toe yoga — 10 reps
- Short foot — 10 reps hold 5 seconds
- Balance — 30 seconds each leg
That's 5 minutes. Do it every day.
After two weeks, add:
- Inversion with resistance band — 2 × 10 reps
- Calf stretch — 2 × 30 seconds
Keep building from there.