Really no different than Achilles tendon rehab with a "twist" (pun intended), need to do bent knee eccentric exercises (heel drops) in minimalist shoes (more forgiving for triplanar motion). The emphasis should be on holding the foot in a supinated (inverted) position at the drop of the motion. The PT is the primary midfoot stabilizer with a huge lever arm wrapping around inside of ankle to bottom of foot.

FWIW, orthotics often fail because your maximal load on the PT is when the heel first comes off the ground and there is no effect of the correction in a traditional orthotic at that point as most have it in the rear/mid foot.

If you are a late pronator (which I suspect you are) than you may want to consider getting a different opinion on orthotic.

Here is example of someone in "custom" orthotics with late pronation:



Cheers!

Thanks, appreciate the info!

You mention getting another opinion on orthotics - if it works as you say, when the heel lifts off the ground, is there really any kind of orthotic that will help that?

Thx!

Lots of caveats, here is what worked for this case and several others along with the usual rehab...

Disclaimer: Late pronation is only bad if it causes symptoms and this fix is not for general use

The traditional concept of a foot orthotic is a rear foot correction via a "post". Late pronation needs a forefoot correction with the general concept of bring the floor closer to medial side of forefoot i.e. under the big toe (first MTP). So when the big toe is trying to get to the ground and bear the load it doesn't have to go as far i.e. less pronation which means less stress on TP.

This is sometimes called an inverted orthotic or more simply put forefoot posting. It can be done in many ways, shapes and forms and I find it works best with a transverse arch support (metatarsal pad). The details of the correction are dependent on a good evaluation of the foot and overall biomechanics of the lower half when running.

In addition, there are a few shoes that have a "posting effect" on the medial forefoot which also can help ex. Mizuno Paradox, formerly Nirvana. It has its waveplate that runs the entire length of the midsole with harder material on the inside (medial) portion.

Here is the above patient after corrective orthotic (forefoot only) and different shoe, same category (stability) but with forefoot support.

BTW, this can be done is a neutral shoe as well. Good luck, use to see this routinely and can tell you that it usually responds well.

Added arrows to show area of strain reduction on PT tendon.

Good luck!