Exercises to train the tibialis posterior muscle. Anatomy of exercise. Stretching exercises

The posterior tibial muscle (PTM) is located between the small and large tibia bones of the leg and is attached to the interosseous septum. She occupies the deepest position. Above it are the flexor muscles of the fingers, the flexor of the thumb and the muscles of the lower leg. Its base is located closer to the heads of the tibia.

MBA functions:

Forming the arch of the foot, lifting it up. This is an isolated movement.
Stabilization of the fibula. If the fibula is not properly secured, it will become loose. Friction between the heads of the tibia and fibula causes knee instability. This gradually leads to arthrosis of the knee joint. Instability also occurs in the ankle joint, and the position of the talus changes. It moves slightly forward, which limits the flexion and extension of the foot. This is especially important for athletes, since the stride shortens during walking and running. If this phenomenon is observed in one leg, over time it leads to the formation of a difference in the volume and tone of the buttocks.
Supports the arch of the foot and stabilizes the knee joint.

It may seem that the MBA is just holding up the arch. But if its functions are weakened, the location of the hip, knee, and bones of the lower leg changes. This leads to various pathological changes in the skeleton and pain, poor posture, and degenerative changes in the spine.

If the backbone is weak, other muscles cannot work correctly: neither the gluteal muscle nor the extensors of the fingers. They turn off during movement, during a step. This causes pain and discomfort, ultimately leading to decreased mobility of the lower leg.

Weakness of the tibialis posterior muscle provokes weakness of the ligamentous apparatus of the foot; all the small bones that form its arch diverge to the sides, this leads to flat feet.

The transverse and longitudinal arch of the foot forms the tone of this muscle. The effectiveness of all legs depends on it.

Principles of MBA training

To restore the functions of the hip joint, you need to perform a special set of exercises to reduce it, and also tone it with every step. This is possible if the foot extends well with each step.

Isolated movement of the hip joint occurs when the foot moves inward. Only the tibialis posterior muscle works this way.

For athletes and those who have weakened muscle tone, if they have flat feet, it is important to follow the principles of training and exercise regularly, this is the only way to achieve results.

How to restore the tone of the tibialis posterior muscle

It is very difficult to influence the MBA from the outside. You can get to it between the calf muscle and the tibia.

You can do the massage yourself by doing the following:

tapping on the posterior tibia from the bottom to the top and in the opposite direction. At the same time you need to move your foot left and right. This will enhance the effect. Tapping should not be forceful; using force will only cause harm;
pressing with the thumbs or the base of the palm along the tibia from the inside from the base of the hip bone to the foot. Closer to the ankle joint, there are nerve endings in this place and pressure can be very painful.

You need to work out the muscle well with a massage, relax tense areas and then begin the exercises.

To treat flat feet, you need to start training to maintain and restore the tone of the backbone with static exercises.

While sitting, place your feet on the floor. You need to press on the inside of the foot in the toe area. At this time, apply resistance with your foot for several seconds. In this case, the knee does not move and remains in a static position. Perform up to 10 repetitions.
While sitting on a chair, move your foot, without lifting it off the floor, inward towards the other foot. The heels stand still, the toes move towards the opposite leg. Do 10 repetitions for each leg.
Do exercise 2, but with both feet at the same time. When your fingers touch, press against each other for 3 seconds. The feet seem to be trying to move inward, but they interfere with each other. Perform 5 to 10 repetitions.

The second stage of the training is exercises for the tibialis posterior muscle with a rubber band.

Fasten the tourniquet and make a loop. Place the loop on your foot and sit on the floor with your leg extended forward. Make an isolated movement of the foot (rotating the toes inward with effort) with a tourniquet draped over it. The number of times is individual, until the muscle becomes tired. This version of the exercise can be performed while sitting on a chair.
This movement should be used when the first exercises after a fracture are performed with ease. You need to place your foot on the step along the edge. It is advisable that half of the foot hangs slightly from the elevation. Now you need to rise a little, shifting your body weight to the foot of your working leg, then return to the starting position. Perform until you are tired, it is important not to overdo it.

To restore and maintain the tone of the brain, you need to carefully and calmly perform the entire complex and massage every day. Regular training of the tibialis muscle will return it to its former functionality.

This syndrome is a cause of medial hindfoot pathology that is often overlooked and misdiagnosed, especially in the early stages. This is a direct result of loss of function of the tibialis posterior tendon.
Chronic inflammation leads to degeneration and stretching of the tendon with the formation of interstitial edema, thinning and chronic tendon damage. If untreated, all this leads to disruption of the alignment of the hind and midfoot with pronation of the heel, plantaflexion of the talus, subluxation of the talonavicular joint and, as a result, the formation of a unilateral flat foot.
The tibialis posterior muscle is active during the stance phase, engages immediately after heel contact, and quickly stops contracting after heel lift. Its belly begins deep within the posterior portion of the lower limb, and the tendon follows down to the posterior portion of the medial malleolus, where it is anterior to the flexor digitorum longus tendon, the posterior tibial neurovascular bundle (posterior artery, vein, and nerve), and the flexor pollicis tendon. All of these structures are limited to the flexor retinaculum near the medial malleolus. The tendon of the posterior b/b muscle passes in the groove behind and below the medial malleolus, dividing into 3 parts at the medial side of the talus. The anterior part is attached to the tuberosity of the scaphoid, the middle part continues into the plantar tarsal region and is attached to the plantar part of the sphenoid bones, the cuboid and at the base of the 2, 3 and 4 metatarsals. The posterior portion is inserted as a fascicle into the anterior portion of the inferior calcaneonavicular ligament. The medial malleolus acts as a multi-roller pulley, allowing the posterior b/w tendon to change direction of pull, and these attachment points provide supination of the hindfoot and midfoot during weight bearing while stabilizing the midfoot arch structure.
The main function of the posterior muscle is to achieve supination in the subtalar joint and adduction of the forefoot around the oblique axis of the midtarsal joint.
. At the beginning of the stance phase, the posterior b/w muscle contracts eccentrically to slow down the pronation that occurs at the subtalar joint and during internal rotation of the b/w bone.
. During mid-stance, the muscle contracts concentrically, providing stability to the midtarsal joint in preparation for propulsion.
. At heel strike, this provides a plantar torque that lifts the heel off the ground.
Thus, the posterior b/b muscle acts as a primary stabilizer against posterior valgus, anterior abduction, and as an antagonist of the peroneus muscles, especially the peroneus brevis.

Etiology.
The causes are unclear and are associated with the following conditions:
. Obesity
. Excessive pronation of the foot, which leads to compression and disruption of the blood supply to the tendon that goes around the medial malleolus deep under the support.
. Structural and anatomical abnormalities, eg accessory navicular, rigid or mobile pes planus, proliferation of osteophytes in the medial malleolar groove, shallow groove and equinus of the ankle joint.
. Inflammatory joint diseases, RA, seronegative arthritis
. Collagen vascular diseases
. Direct trauma when the tendon is torn by fragments of the medial malleolus
. Indirect trauma such as ankle fracture, eversion ankle sprain, acute avulsion injury of the scaphoid and posterior b/w tendon displacement
. Iatrogenic effects (injection of steroids into the area)
Pathology.
The concept of dysfunction can be divided into 4 stages:
1. Asymptomatic stage. Assessment of the patient may reveal underlying abnormalities that may lead to the development of dysfunction. For example, fully compensated hindfoot varus, or obesity.
2. Stage of initial symptoms. Tendonitis (inflammation of the tendon sheath in the area of the flexor retinaculum). Mild weakness of the b/w muscles.
3. Stage of severe dysfunction. Characterized by damage within the tendon, elongation without damage, even separation of the tendon from the rook. Pronounced pronation of the middle section and abduction of the anterior section.
Other classification:
. Acute phase. Lasts 2 weeks after onset, during which tendon pathology may not be diagnosed. Typically: diffuse swelling, tenderness on the medial side of the ankle joint. There may be soreness and fatigue in the muscles of the lower limb.
. Subacute phase. Lasts from 2 weeks to 6 months. There is pain and swelling along the tendon, from the back of the medial malleolus to the internal longitudinal arch. This may also be a symptom of tarsal tunnel syndrome due to compression of the local nerve. Passive movements in the subtalar and midtarsal joints usually do not cause pain, but the gait changes, there is no push, the anterior part is abducted, there is no supination when the heel and toes are lifted off.
. Chronic phase. Occurs in approximately 6 months. Patients have unilateral rigid flat foot. In advanced cases, pain may move from the medial to the lateral part of the tarsal sinus. Lateral pain occurs due to progressive hindfoot valgus, which leads to calcaneofibular axial loading, periosteal inflammation, peroneal tendonitis, and subtalar tendinitis.
Clinical picture.
In approximately 50% of cases, it is preceded by local trauma - severe eversion of the posterior segment.
Women over 40 years of age and younger athletes are more often affected.

Patients often do not seek help in the early stages, in the 1st or acute phase, because... symptoms are mild.
. Patients usually present in stage 2 or subacute phase, with diffuse swelling and heat in the medial ankle and along the tendon. Patients experience difficulty or a feeling of instability when lifting the heel on the affected side, and the heel does not supinate when lifting it off the surface.
. In stage 3 or the chronic phase, the patient notices a gradual decrease in the height of the longitudinal arch, the development of a flat foot on one side, and fatigue in the lower limb when walking. When viewed from behind, there is excessive abduction of the forefoot (too many toes). In severe cases, loss of the longitudinal arch, eversion of the calcaneus. Excessive wear on the medial heel of a shoe.
Diagnosis and differential diagnosis.
The integrity of the posterior b/b tendon is assessed by palpation when the patient actively plantarflexes and adducts the foot and the examiner applies abduction force to the forefoot. It is important to determine the exact location of the injury within the tendon and compare it with a healthy foot. Direct pressure along the course of the tendon may reveal pain, and active inversion of the foot against resistance may reveal decreased strength of the posterior abdominal muscle. If there is partial damage to the tendon, this can be palpated.
If the tendon is completely damaged, the tendon will not be palpable along its normal bed and the patient will not be able to invert the foot against resistance.
Partial or complete damage due to trauma is accompanied by various pains in the area of the tuberosity of the scaphoid bone. Overuse injuries and tendon degeneration present with pain distal to the medial malleolus.

MRI is the most useful method for examining the tendons around the ankle and identifying damage. Other diagnostic tests include a bone scan and injection of radiocontrast material into the tendon sheath. Early diagnosis is not improved by direct radiographs, however, examination of the foot will indicate the extent of structural changes in stage 3. A standard anteroposterior radiograph shows an increase in the angle between the longitudinal axis of the talus and the longitudinal axis of the calcaneus, abduction of the forefoot, and displacement of the 2nd metatarsal. The long axis of the forefoot no longer bisects the angle of the hindfoot. Normally, the linear relationship between the talus, navicular, medial cuneiform, and first metatarsal is lost on the lateral radiograph.
If the situation progresses, then osteoarthritis of the 1st metatarsophalangeal joint, secondary to hallux limitus, appears.
The differential diagnosis should exclude:
bone abnormalities
1. scaphoid syndrome (os tibiale externum), triquetrum syndrome, scaphoid avulsion, scaphoid stress fracture
2. osteochondritis or avascular necrosis of the head of the talus or navicular
3. fracture of the medial malleolus
4. subtalar tarsal coalition
5. inflammation of the medial sinus tarsi
soft tissue disorders:
1. deltoid ligament sprain
2. medial capsulitis of the ankle joint
3. Tarsal tunnel syndrome
4. Stretching the flexor pollicis longus or flexor digitorum longus muscles
5. posterior calcaneal bursitis
Other cases of unilateral flat foot (difference in leg length, true or relative, tarsal coalition) should also be taken into account when making a diagnosis.
Treatment.
Treatment depends on the stage or phase of the disease. Treatment must be done quickly and aggressively to prevent further deterioration. In the early stages - reduction of inflammation, joint stabilization, pain control - up to 8 weeks. In more severe and persistent cases, surgical repair of the tendon with joint fixation is possible.
Conservative treatment: NSAIDs, ultrasound, taping of the hindfoot in an inversion position to reduce tension in the tendons. Orthotics with soft temporary orthoses (valgus pads, medial pads under the entire foot - cobra) are used to invert the hindfoot. Individual rigid antipronator orthoses enable the posterior b/w muscle to function more efficiently, because targeted at the underlying pathomechanical defect. The orthosis controls movement at the subtalar joint, reducing tendon stretch by controlling anterior abduction (using the lateral flange). Exercise therapy is aimed at strengthening the posterior b/w muscle. More severe cases require immobilization of the foot in an inverted position in a plaster cast up to the knee for several weeks. Steroid therapy is not used due to the potential for damage to the already weakened tendon.
Surgical treatment is indicated at stage 2 or in the subacute phase. If there is no effect from 8 weeks of conservative therapy or in the 3rd stage and 4th phase. In persistent cases with moderate tenosynovitis but no obvious tendon damage, tendon release and synovectomy are indicated.
Synovectomy, tendon insertion strengthening, or flexor digitorum longus transfer are indicated in more severe cases characterized by tendon elongation.
Severe cases with complete damage or fibrosis of the tendon are treated with transplantation of the flexor digitorum longus, shortening of the ligaments and talonavicular capsule, and surgical widening of the bony canal under the medial malleolus. Arthrodesis of the hindfoot joints, such as between the talus and calcaneus, subtalar arthrodesis, talonavicular fusion, or combined talonavicular and calcaneocuboid arthrodesis may be indicated in advanced stages with pain in the lateral hindfoot.
The results of corrective surgery are not always straightforward. The procedure requires a long period of recovery, rehabilitation, and exercise. The amount of postoperative correction of planalgus in degrees is difficult to predict accurately, however, an increase in stability during the period of support can be expected. Osteoarthritis of the joints in the hindfoot develops over a long period of time, because... When normal joint alignment is disrupted due to arthrodesis, the repaired tendon may weaken in the future with a return of preoperative symptoms.

The tibialis posterior muscle originates from the junction of the tibia bones at the top of the ankle and passes into a long, strong tendon at the bottom. It passes through the talus bone of the heel and attaches to the metatarsal bones. In Latin, this deep muscle is called tibia posterior, which literally means “back flute” or “pipe.” It is elongated and long, widening slightly at the base and narrowing towards the end. The anatomy of this amazing muscle determines its functions; it is involved in the process of unfolding the foot, in plantar extension and flexion of the ankle joint.

Location and functions

The photo shows the anterior and posterior tibial muscles

MBA functions:

Forming the arch of the foot, lifting it up. This is an isolated movement.
Stabilization of the fibula. If the fibula is not properly secured, it will become loose. Friction between the heads of the tibia and fibula causes knee instability. This gradually leads to arthrosis of the knee joint. Instability also occurs in the ankle joint, and the position of the talus changes. It moves slightly forward, which limits the flexion and extension of the foot. This is especially important for athletes, since the stride shortens during walking and running. If this phenomenon is observed in one leg, over time it leads to the formation of a difference in the volume and tone of the buttocks.
Supports the arch of the foot and stabilizes the knee joint.

If the backbone is weak, other muscles cannot work correctly: neither the gluteal muscle nor the extensors of the fingers. They turn off during movement, during a step. This causes pain and discomfort, ultimately leading to decreased mobility of the lower leg.

A sign of weakness in the cervical spine is pain in the calf area.

Weakness of the tibialis posterior muscle provokes weakness of the ligamentous apparatus of the foot; all the small bones that form its arch diverge to the sides, this leads to flat feet.

The transverse and longitudinal arch of the foot forms the tone of this muscle. The effectiveness of all legs depends on it.

Causes and consequences of weakening the BMS

Pain in the leg when the sciatic nerve is compressed is a consequence of weakness of the cervical spine

As a result of loss of tone, tendinopathy of the posterior tibialis muscle develops - the tendon of the posterior tibial muscle undergoes pathological changes. The main symptom of this disease is an unpleasant sensation, especially after walking or running, in the area of muscle attachment, ligament and localization of the ligament.

Inflammation in the muscles, vessels, veins and arteries of the leg is also very likely.

It becomes difficult for them to supply the muscle with blood in the required volume, as a result it partially loses its functions.

Weakness of the backbone not only causes flat feet, but also inhibits the development of the gluteal muscle. In this case, it will be possible to pump up the buttocks only after the functions of the hip joint have been restored.

Principles of MBA training

Daily exercises to restore the functions of the brain can be performed at home

To restore the functions of the hip joint, you need to perform a special set of exercises to reduce it, and also tone it with every step. This is possible if the foot extends well with each step.

Isolated movement of the hip joint occurs when the foot moves inward. Only the tibialis posterior muscle works this way.

This movement is used for its training and development.

For athletes and those who have weakened muscle tone, if they have flat feet, it is important to follow the principles of training and exercise regularly, this is the only way to achieve results.

How to restore the tone of the tibialis posterior muscle

Massage will help restore muscle tone

It is very difficult to influence the MBA from the outside. You can get to it between the calf muscle and the tibia.

You can do the massage yourself by doing the following:

tapping on the posterior tibia from the bottom to the top and in the opposite direction. At the same time you need to move your foot left and right. This will enhance the effect. Tapping should not be forceful; using force will only cause harm;
pressing with the thumbs or the base of the palm along the tibia from the inside from the base of the hip bone to the foot. Closer to the ankle joint, there are nerve endings in this place and pressure can be very painful.

You need to work out the muscle well with a massage, relax tense areas and then begin the exercises.

To treat flat feet, you need to start training to maintain and restore the tone of the backbone with static exercises.

While sitting, place your feet on the floor. You need to press on the inside of the foot in the toe area. At this time, apply resistance with your foot for several seconds. In this case, the knee does not move and remains in a static position. Perform up to 10 repetitions.
While sitting on a chair, move your foot, without lifting it off the floor, inward towards the other foot. The heels stand still, the toes move towards the opposite leg. Do 10 repetitions for each leg.
Do exercise 2, but with both feet at the same time. When your fingers touch, press against each other for 3 seconds. The feet seem to be trying to move inward, but they interfere with each other. Perform 5 to 10 repetitions.

The second stage of the training is exercises for the tibialis posterior muscle with a rubber band.

Fasten the tourniquet and make a loop. Place the loop on your foot and sit on the floor with your leg extended forward. Make an isolated movement of the foot (rotating the toes inward with effort) with a tourniquet draped over it. The number of times is individual, until the muscle becomes tired. This version of the exercise can be performed while sitting on a chair.
This movement needs to be connected when the first ones are performed with ease. You need to place your foot on the step along the edge. It is advisable that half of the foot hangs slightly from the elevation. Now you need to rise a little, shifting your body weight to the foot of your working leg, then return to the starting position. Perform until you are tired, it is important not to overdo it.

In the video you can see the anatomical structure of the lower leg and foot, and see the basic exercises to maintain the functions of the hip joint.

Karina Grishanova | 05/07/2015 | 2597

Karina Grishanova 05/7/2015 2597

If you dream of a beautiful gait, these exercises are necessary for you.

It's time for open sandals and high heels. To feel confident in such shoes, you need to strengthen the muscles of the foot and ankle joint. Regular training will make your gait stable and beautiful, and will also protect you from injuries that may occur while walking or running.

What muscles need to be trained?

There are 5 main muscles involved in foot movements:

gastrocnemius And soleus provide flexion of the foot on the side of the sole;
anterior tibial extends the foot;
peroneus muscle not only bends the foot, but also moves it to the side;
tibialis posterior muscle responsible for stabilizing the ankle joint.

To walk beautifully and confidently, you need to work on all these muscles.

Examples of exercises

We bring to your attention several exercises aimed at strengthening the muscles of the foot. Their main advantage is that they can be performed at home or in the office: no special equipment is required.

Foot stretching

Initial position: sitting on the floor, straight legs extended in front of you. Pull your feet alternately away from you and toward you. Make sure that your heel, big toe and little toe remain in the same plane during the exercise. Do not curl your toes under the arch of your foot. Repeat 10 times.

Circular movements of the feet

Initial position: former. Perform circular movements with your feet, first inward, then outward. Try to touch the floor with the bone of your thumb when rotating inward and with your little finger when rotating outward. Do 10 movements in each direction.

Exercise on your knees

Initial position: kneeling on the floor. From the starting position, sit on your feet so that the big toes and heels of both feet are close to each other. Stay in this position for 1 minute.

Exercise with a towel

Initial position: Lay a medium-sized rectangular towel on the floor and stand on one end of it. Without lifting your heels off the floor, gradually pull the towel towards you using your toes. Then straighten the towel and repeat the exercise 10 times.

Lifting on fingers

Initial position: standing, back straight. Rise up onto your toes as high as you can. Keep your heels elevated and begin to gradually bend your knees. In a half-squat position, place your heels on the floor and only then straighten your legs. The knees and ankles should remain straight, with no deviation outward or inward. Repeat 10 times.

If you can't do the exercises regularly, practice picking up small objects from the floor with your toes as often as possible. You can even do this at work: scatter pencils or paper clips under the table and study.

How often should you train?

For the greatest effectiveness of the exercises, you need to perform them every day. Don’t worry: the whole complex will take you no more than 10 minutes, but your gait will improve in just a couple of weeks.