Generally PT tendon issues are one of dysfunction and not tendonitis and as such are treated different. You can't often "stretch or therapy" your way out of PTTD, though it depends a lot on why you developed your suspected posterior tibial tendon issues. Best to get a competent hands on exam here.

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Calf raises. Lots of them. Every other day until you can do at least 15 single leg calf raises without stopping. That's what worked for me. You can add weights too. There are lots of resistance band exercises but they never really worked much for me. It seems to me like you can get much more benefit from strengthening the muscles (the gastrocnemius and soleus) than from trying to strengthen tendons (if that's even possible).

I tried acupuncture too. I think there's a pretty strong placebo effect with it, if you believe it might work, then it might work. But I didn't think it was worth it, and getting needled in the feet is one of the more painful places.

Also...I'd do both standing and bent knee calf raises. When you bend your knee you strengthen the soleus, when you keep your knee straight you work the gastroc. Check here - http://livehealthy.chron.com/...trocnemius-8104.html

But I'll reiterate the previous comment...I had a physical therapist do a hands-on exam and tell me exactly what tendon was injured and why. But after all that I do believe that something like the above strengthening regimen is important for any runner.

FYI dry needling and accupuncture quite different. I won't debate the effectiveness of either, but just leave at 'they are different'

PT issues can be a bummer, sorry.

As rroof mentioned, get a good comprehensive clinical evaluation. Need to find the cause of the dysfunction and the foot/ankle is the first point of contact with the ground but it can be affected from further up the chain. Get your hip ROM and strength checked because dynamic hip stabilizers are important (glute medius integration).

Next have someone evaluate how much true dorsiflexion (ankle up) you have at your ankle joint. I see a lot of my runners come in with "false" motion and tend to pronate to achieve the true dorsiflexion because of a joint restriction or capsular issue. The tends not to have enough rotation backwards on the lateral side. Previous ankle injury is a risk factor.

This overpronation will certainly stress the tendons (3) posterior to the inside ankle bone, one of which is the PT. But this overpronation or collapse can come from somewhere else. Thats why its important to have a good differential diagnosis and cause.

But to answer your first question, strengthening the PT is very specific because the larger muscles (gastro/soleus) will overpower it, thats their job anyways. Can't simply do a "basic" calf raise. You need to isolate the PT as much as possible. It assists in pulling your foot down and turning it inwards so:

Similar to a calf raise except you need to turn your heels out to the side (inversion) and try and lift your toes off the ground slightly. By doing this you take the big toe flexor and the other 4 toe flexor out of the equation (these are the other 2 tendons that run behind the inside ankle bone with the PT). Essentially you are trying to do a heel raise with your heel out to the side and your toes up so the weight is through the ball of your foot. Up and down very slowly. You should start sitting and then work your way up to standing full body weight.

...get it checked out first. Good luck!

I am interested in the exercise in bold, but I am having difficulty visualizing...can you point me to a video?

Hey Dev, sure thing! I know its tough to visualize and I think it was late, so I got lazy. Check out the link below. Its a progression so there are a couple of options to regress the exercise if its not appropriate for someone yet (pain or poor execution).

https://www.youtube.com/watch?v=c48fElpebeY

Around the 2min mark he starts to describe why its important to try and keep the toes lifted. FHL, FDL and PT are the 3 tendons that course down the inside of the lower leg and will all help produce similar motion (hence the synergist effect). Lifting the toes simply helps try and inhibit the FHL and FDL so the PT can try and be isolated as much as possible.

Brent is one of a few people I like to follow in the rehab world. I don't always agree with of the info thats out there but I definitely like to pick and choose from a few here and there, whatever best suits my patient population. To me this helps with the progression of exercises/rehab/strengthening towards more of a functional approach than simply isolating muscles for the sake of isolating. Sometimes we need to isolate a muscle just to activate it, but that strength must be integrated somehow and fairly soon. This bodyweight exercise for PT is far more functional than a band-resisted exercise while laying down, provided that full bodyweight and gravity is not too much stress on the tissue. If it is, then we regress a bit.

John

I got the strap in the video below and followed thier dvd (footstrengh.com - no longer on line).
I had chronic issues and the strap was the only thing that seemed to traget that specific area. (for me anyways)