Strengthening the Tibialis Posterior and Peroneus Longus
The tibialis posterior is one of the deepest and strongest muscles of the lower leg. It lies deep in the calf region, runs down the inside of the ankle, and underneath the foot inserting into almost every structure in the bottom of the foot. It is the strongest invertor of the heel and plays a major role in stabilizing the foot. A study by Kulig, et al showed that performing foot adduction exercises activated the tibialis posterior more effectively than doing heel raises.
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Foot adduction with plantarflexion. Actions of the tibialis posterior. Notice the tendon tensed behind the medial malleolus (inside ankle bone.)
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Adapted from Michaud, T.
1. Foot Adduction Exercise. Tibialis Posterior.
This exercise allows the patient to perform eccentric load exercises by lifting the involved forefoot by hand (to avoid the concentric phase) while using tibialis posterior to actively lower the involved forefoot during the eccentric phase. The eccentric portion of the exercise should last 3 seconds and the patient typically performs three sets of 15 repetitions daily.
This exercise allows the patient to perform eccentric load exercises by lifting the involved forefoot by hand (to avoid the concentric phase) while using tibialis posterior to actively lower the involved forefoot during the eccentric phase. The eccentric portion of the exercise should last 3 seconds and the patient typically performs three sets of 15 repetitions daily.
Using the hand, place the foot into a fully adducted and plantarflexed starting position...
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Hold this position for 3 seconds using the tibialis posterior contraction...
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Notice Tib. posterior tendon standing out along inside of ankle.,
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Slowly lower the foot toward the floor in 3 seconds. Repeat. 15 reps, 3 sets, daily.
 Peroneus Longus contracting. Notice the tendon standing out along the outer lower leg. The first ray (metatarsal) is also strongly flexed.
2. Peroneus Longus.
Another muscle that is important to train is the P. longus. Originating from the outside of the calf and lower leg region, it mirrors the function of the tibialis posterior with which it creates a tendon mesh-like cradle under the foot. Thera-band exercises work great to strengthen. However, since the main function of the P. longus is to strongly flex the first metatarsal down to the ground during propulsion, it is imperative that this muscle be trained as such. This mimics its function during gait. |
Adapted from Michaud, T.
A simple peroneus longus exercise is performed by plantarflexing and everting the forefoot against resistance from an elastic band (A). A more advanced peroneus longus exercise is performed by standing with hips abducted and knees flexed while plantarflexing and everting the ankles (B). 3 sets of 15 reps can be used in each.
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