Foot Health Blog
Find expert articles from physical therapists and podiatrists to help understand, diagnose, and treat different foot health issues such as plantar fasciitis, bunions, flat feet, and more.
Posterior tibial tendonitis7 Best Insoles for Posterior Tibial TendonitisPosterior tibial tendonitis is a leading cause of pain in the foot. Research suggests that orthotics and insoles are effective at reducing the symptoms associated with posterior tibial tendonitis. They provide necessary arch support, thereby relieving pain and cushioning the feet.
In a market filled with varying brands of orthotics, it may become overwhelming to choose the best support for your feet. That’s why we've compiled a list of the seven best insoles for posterior tibial tendonitis so you can make an informed choice.
7 Best Insoles for Posterior Tibial Tendonitis Recommended by Top Podiatrists
1. Upstep Achilles Tendon Custom Orthotics2. SOLE Signature DK Response Insoles3. Superfeet Run Pain Relief Insoles4. Protalus M-100 Insoles5. URthotics Comfort+ Insoles6. Tread Labs Pace Short Insoles7. FitMyFoot 3/4 Length Insoles (Zircon)
1. Upstep Achilles Tendon Custom Orthotics
Without a doubt, Upstep Achilles Tendon custom orthotics are the best insoles on the market for treating posterior tibial tendonitis. Expert podiatrists factor in the foot condition and make suitable custom-fitted insoles to correct it. This makes them very effective in relieving any pain symptoms.
Upstep insoles aim to provide you with a long-term solution that fits into your lifestyle and allows you to go on with your everyday activities and support you during exercise. Upstep insoles are durable, maintain body alignment, and restrict abnormal foot motion. Additionally, they are also covered by HSA and FSA insurance plans.
2. SOLE Signature DK Response Insoles
SOLE insoles come with a firm but flexible support and deep arch support that ensures proper foot alignment and limits the strain of the plantar fascia. It's not custom-fitted to the client’s feet. Instead, it uses moldable orthopedic bases that require heating to shape them to the foot contours. This makes the insoles less effective to treat posterior tibial tendonitis.
» How does posterior tibial tendonitis progress? There are 4 stages of posterior tibial dysfunction
3. Superfeet Run Pain Relief Insoles
Superfeet Run insoles are effective store-bought insoles, designed to stabilize the foot and reduce repetitive stress during running and other athletic activities. It also provides cushioning for the heel, reducing the impact of heel strikes on the feet.
Like SOLE insoles, they're not custom-fitted to the size of the feet and may become squeaky if they're not well-trimmed. Therefore, they're also less effective to treat posterior tibial tendonitis, because they're generically designed and don't factor in individual foot pathology.
» Can orthotic insoles treat posterior tibial tendonitis? Read up on the effectiveness of using orthotic insoles
4. Protalus M-100 Insoles
Protalus M-100 insoles guarantee proper arch support and are ideal for larger and wider shoes. They improve heel stability and cushion the heel bone, guaranteeing more comfort. These insoles are widely available for purchase online.
While they make good replacement insole, Protalus insoles have limited effectiveness in addressing conditions like posterior tibial tendonitis because they're not fitted. Also, the cushion typically flattens out within four to six months of repeated use.
5. URthotics Comfort+ Insoles
Urthotics Comfort+ insoles are custom-fitted to the foot and help to manage conditions where there is pain in the ball of the foot. They're also ideal for people with sensitive feet as they provide adequate cushioning and comfort as needed.
Urthotics Comfort+ insoles come in a 3/4 length and can be purchased with HSA and FSA cards. Since they don't particularly provide support for the medial arch (which is what is needed with posterior tibial tendonitis), they're not the most-suited insoles to correct posterior tibial tendonitis.
» Learn more about the best exercises for posterior tibial tendonitis
6. Tread Labs Pace Short Insoles
Pace insoles provide firm arch support resulting in pain relief and improved foot alignment. They also improve shock absorption, stability, and balance in the feet. These insoles come in multiple sizes and arch heights, allowing you to choose a fit that's as close as possible.
Pace insoles are best used with shoes that have removable inserts and are most suitable for plantar fasciitis, not posterior tibial tendonitis.
» Find out how long it takes to recover from posterior tibial tendonitis
7. FitMyFoot 3/4 Length Insoles (Zircon)
FitMyFoot 3/4 length insoles have enhanced arch support that optimizes comfort, reduces foot pain, and improves body alignment. They're made using flexible materials that increase their durability and are molded according to the 3D foot imprint sent to any interested buyer.
They're best used with shoes that have removable inserts and improve the shoe fit. However, the brand has a returns policy that makes the client responsible for the shipping costs if the insole return happens within 30 days of purchase.
» Discover the best insoles for tennis players with posterior tibial tendonitis
Final Verdict
Between all seven orthotics, you’ll find one that will address your pain needs and aid your recovery process. However, if you needed to choose the best insole for managing posterior tibial tendonitis, custom orthotics are the answer because they're physically made to fit your feet and address your foot pathology as opposed to store-bought orthotics that provide general support only.
Posterior tibial tendonitis6 Best Insoles for Tennis Players With Posterior Tibial TendonitisPivots, quick forward and sideways movements, sudden jars and jolts—tennis can be rough on your lower limbs. But if you have posterior tibial tendonitis, the resulting pain, instability, and unsteady gait can worsen your gameplay and limit your performance significantly.
However, wearing the right insoles can help you manage your symptoms by providing the necessary arch support, relieving pain, and minimizing the strain on your posterior tibial tendon.
Now, we know the number of insoles available in the market can make it hard to decide. That’s why we've compiled the below list to give you a head start.
» Experiencing Achilles tendon pain after playing tennis? Prevent discomfort with the best tennis shoes for Achilles tendonitis
1. Upstep | Achilles Tendon Custom Orthotics
ProsCustom-madeComfortable and durableAt-home impression kitFSA & HSA eligible180-day money-back guaranteeConsShort waiting period before receiving orthotics
Upstep has some of the best insoles for posterior tibial tendonitis. Designed based on your foot shape, Achilles Tendon Custom Orthotics from Upstep improve comfort and keep your feet in an optimal position to reduce any strain and redistribute your weight equally. Made to fit your lifestyle and address the specific causes of your condition, these custom insoles are affordable and durable.
2. Superfeet | ME3D Max Insoles
ProsCustom-made3D printedOdor control60-day guaranteeConsBiometrics must be measured at a retailerWaiting period before receiving insoles
Superfeet ME3D Max Insoles are custom-made according to your foot biometrics. These 3D-printed insoles are covered with Poron® Vive foam for extra cushioning and odor control. The personalized arch support increases your stability and enhances your natural motion, thereby improving your overall performance during a tennis game.
However, your biometrics can only be measured in person at a retailer. This may be inconvenient compared to the at-home kits of competitors.
ME3D Max Insoles
3. SOLE | Softec Response Insoles
ProsEco-friendly recycled wine cork baseSuitable for most athletic shoesOdor controlConsNot specifically designed for tennis players or posterior tibial tendonitisMolding process may result in incorrect fit
Softec Response Insoles from SOLE have a versatile fit and are suitable for a range of activities. They provide moderate cushioning and aim to improve balance, while encouraging natural foot alignment to distribute any weight and pressure placed on your feet equally.
However, the "do-it-all" footbed is not specifically designed for tennis players or posterior tibial tendonitis, instead targeting overall athletic activities and other conditions like plantar fasciitis. The insoles must also be molded to your feet after applying heat. If done incorrectly, the molding process can provide insufficient support.
Softec Response Insoles
4. Protalus ET-75 Insoles
ProsThin and comfortable designSuitable for low-volume shoesAnti-slip ridges90-day money-back guaranteeConsNot custom-madeMay not find ideal fit and support
Protalus ET-75 Insoles feature a unique tri-planar alignment system that aligns your body neutrally to reduce pressure, increase comfort, and provide support with each step during a game. The anti-slip ridges secure the insoles in your shoes while the thin design is ideal for low-volume and narrow shoes.
However, these insoles are not custom-made and you may not find a size that provides the ideal fit and support.
ET-75 Insoles
5. TreadLabs | Dash Thin Insoles
ProsUltra-firm supportCarbon fiber arch support in 4 sizesOdor controlMillion mile guaranteeConsNo custom support or fitMay be better suited for other sports and conditions
TreadLabs Dash Thin Insoles provide ultra-firm support to enhance your biomechanics. The carbon fiber arch support eases the pressure off your feet while maximizing your energy return and boosting your performance while you play.
While the arch support comes in 4 sizes, you may not find the ideal fit for your needs. The insoles may also be better suited to other conditions like flat feet and other shoes like cycling shoes and cleats.
Dash Thin Insoles
6. URthotics | Comfort+ Insoles
ProsCustom-madeAt-home impression kitFSA & HSA eligible6-months money-back guaranteeConsWaiting period before receiving orthotics
URthotics Comfort+ Insoles are custom-made based on your foot imprints and needs. These custom insoles have a soft top layer to increase comfort, especially if you have sensitive feet, and aim to reduce metatarsal pain. The complete contact of the insole with your arches helps to redistribute any pressure placed on your feet while you play tennis.
Comfort+ Insoles
Choose a Custom Orthotics, Choose Upstep
As a tennis player, we don't have to tell you how demanding tennis is, especially regarding your feet. Whether you play recreationally or professionally, if you have posterior tibial tendonitis and are in it for the long haul, you must take proper care of your feet to prevent your condition from worsening (and potential injuries).
Custom orthotics as treatment for posterior tendonitis can help to alleviate and manage your symptoms, because they're designed for you and your needs as opposed to an over-the counter insole that provides blanket support. On the other hand, if you're struggling with plantar fasciitis, rest assured as Upstep has the best insoles for tennis players with the condition.
Posterior tibial tendonitisBest Exercises for Posterior Tibial TendonitisPosterior tibial tendonitis, also known as posterior tibial tendon dysfunction (PTTD), is caused by the inflammation of the posterior tibial tendon that is responsible for plantar flexion (flexing your toes toward your sole) and inversion of the foot. This results in pain in the ankle and the foot and an inability to stabilize the foot during gait. Posterior tibial tendonitis is a common foot condition and must be managed promptly, or else it will lead to more debilitating conditions.
This article briefly discusses some common causes and treatments for PTTD but looks more specifically at various exercises you can perform at home to aid in the healing process.
Possible Causes of Posterior Tibial Tendonitis
Posterior tibial tendonitis often occurs as a repetitive injury due to overuse. It is most common among dancers and athletes involved in high-impact sports. It can also occur acutely with a fall or collision involving the posterior tibial tendon. Generally, women and people over 40 years of age are more prone to having posterior tibial tendonitis.
» Do you feel feet and ankle pain after walking or hiking? Consider investing in fitness walking and hiking custom orthotics to relieve pain, but make sure to read product reviews before purchasing
Common Treatments for Posterior Tibial Tendonitis
Posterior tibial tendonitis is best managed early. Treatment options include rest, activity modification, ice, NSAIDs, braces, orthotics, cortisone injections, and exercises.
In the case of orthotics for posterior tibial tendonitis, they must be custom-built based on the condition. Upstep orthotics are the best custom orthotics you can get, as they are designed by expert podiatrists using the best quality materials to fit your specific feet.
A cortisone injection is also helpful as it provides short-term relief and helps reduce inflammation. This is particularly useful if you’ll be carrying out an exercise regimen.
Apart from relieving pain, exercises can help strengthen the muscles of the lower extremity as well as stretch, improve, and maintain the mobility of the ankle joint. Here are some of the most common yoga-style exercises you can perform for posterior tibial tendonitis:
Stretching Exercises for Posterior Tibial Tendonitis
1. Hamstring wall stretch
Starting position: Supine lying (lying on your back)
Lie on your back next to a wall.Keeping the unaffected leg flat against the floor, slowly slide the affected leg up the wall as if to straighten the knee, ensuring that you do not arch your back or bend a knee while doing this.
Note: As the knee on the affected leg straightens, you’ll feel a stretch down your hamstring muscles.Hold the stretch for a minimum of 1 minute to begin, then continue to lengthen the duration of the stretch as your body adapts to it.Repeat 2 to 4 times.
2. Calf wall stretch
Starting position: Standing
Stand facing a wall with your hands against it at about eye level.Put your affected leg about a step behind your other leg.With your leg straight and your heel on the floor, bend the knee of the unaffected leg and gradually bring your hip and chest toward the wall.
Note: Alternatively, you can start by bending both knees while keeping both heels on the floor. Again, slowly bring the hips and chest back towards the wall. In both cases, you’ll stop when you feel a stretch in the calf of your back leg.Hold the stretch for up to 30 seconds.Repeat 2 to 4 times for a set.
3. Shin muscle stretch
Starting position: Sitting
Keep your feet flat on the floor while sitting in a chair.Transfer weight to your toes by bending the feet, causing the toes to point downwards at the floor. You can hold the chair for support.Once done, you’ll begin to feel a stretch in the front of your shin.Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.
Strengthening Exercises for Posterior Tibial Tendonitis
1. Ankle inversion with resistance band
Starting position: Sitting
Start with both feet flat on the ground sitting with your back straight.Place the lateral border of the affected foot on the knee of the other leg. You can use your hand to stabilize the affected leg at the knee.With your other foot firmly on the ground, pull the resistance band towards the affected leg, letting it rest on the ball of your feet.Slowly invert the foot by pulling on the resistance band. You can support the foot with your hand.Repeat 3-10 times.
2. Forward step downs (for the quads and soleus)
Starting position: Standing
Begin with the affected foot on an elevated surface. You could use a small box or the last step on a flight of stairs.Keeping your head and back straight, bend your knee forwards until the heel of the other foot is almost touching the floor.Slowly return to the starting position.Repeat 10 times.
Importance of Post Care and Exercise
It should be noted that exercise doesn’t bring instant results regarding posterior tibial tendonitis. Rather, the goal is to remodel and reeducate the muscles, strengthening and stretching them in the process. This takes some time, so you must be consistent in performing the exercises until they yield results.
Posterior tibial tendonitisPosterior Tibial Tendonitis: Symptoms, Causes, & TreatmentsThe posterior tibial tendon and the muscles it influences play an essential role in walking and supporting the medial arch. It is the second largest of the extrinsic foot tendons and connects one of the calf muscles to the bones located on the inner foot. Thus, its action causes the foot to plantarflex (flex the toes towards the sole).
When this tendon becomes inflamed, it causes posterior tibial tendonitis, otherwise known as posterior tibial tendon dysfunction (PTTD), and also affects the inner side of the ankle, called the medial malleolus. This often happens because of the compression of the tendon and poor blood supply to the area. Posterior tibial tendonitis is quite common and can become a real problem if not managed promptly.
Symptoms of Posterior Tibial Tendonitis
At the initial stage, posterior tibial tendonitis is characterized by inner foot pain that worsens with activity, swelling and tenderness along the tendon, inability to stand on one foot, an inward rolling of the ankle, turning out of the toes and foot, and unsteady gait.
However, posterior tibial tendonitis is progressive and usually goes through 4 stages, each with varying levels of symptoms and deformities:
Stage 1 is the least symptomatic stage where it is possible to miss the diagnosis.In stage 2, there is a torn tendon that affects the normal functioning of the foot.At stage 3, there is sizeable deformation of the foot along with degeneration of the connective tissue in the hindfoot.By stage 4, the inflammation is full-blown with deltoid ligament compromise and degenerative changes at the ankle joint.
» Read more about the four stages of PTTD and their diagnoses
Causes of Posterior Tibial Tendonitis
There can be multiple different causes of posterior tibial tendonitis, such as:
Acute injury
A fall or high-impact activity can tear the tendon or cause it to become inflamed.
Overuse/high-impact sports
This is especially common in athletes and sports professionals who play high-impact sports, such as basketball, tennis, or soccer.
In addition to these direct causes, obesity, diabetes, and hypertension are considered risk factors, and statistically speaking, females and individuals over 40 are more likely to suffer from this condition.
Treatment of Posterior Tibial Tendonitis
There are many different treatment options available for PTTD before surgery is necessary, which include the following:
1. Rest
Like many other injuries to the foot joint, rest is the first line of management. While total abstinence may be impossible to achieve, activity modification may prove more successful. You can limit walking on the foot to the barest minimum and avoid high-impact activities like running, jumping, jogging, etc.
2. Ice and NSAIDs
Next to rest is the use of ice and non-steroidal anti-inflammatory drugs (NSAIDs). At the acute phase, these can be used to control inflammation and thus reduce symptoms.
3. Braces
Braces can support the foot joints and reduce strain on the posterior tibial tendon. Utilizing a brace early enough can limit the progression of PTTD as well as relieve pain, strengthen the tendons, and aid in the healing process.
4. Exercises
ROM exercises for the ankle (passive or active) will help you maintain optimal mobility. This will allow you to move fully and without pain in all directions, so stiffness and other complications do not result. General flexibility exercises can also improve mobility in the lower limb muscles while maintaining foot alignment in walking.
» Learn how to alleviate any possible discomfort with the best exercises for posterior tibial tendonitis
5. Custom Orthotics
Using custom orthotics is another early treatment option. Upstep orthotics are particularly useful in treating this condition as they can relieve pain and improve your mobility. Additionally, they support the foot and help restore normal foot position. Upstep orthotics are helpful because they are tailored to your specific condition regardless of the stage or severity of your symptoms.
6. Surgery
When pain persists despite conservative treatments at the early stages, surgery becomes the only option left. The surgical approach depends on the location of the tendonitis and the severity of the damage. Standard surgical procedures include lengthening of the calf muscles, tenosynovectomy, tendon transfer, osteotomy, and fusion.
Posterior Tibial Tendonitis Relief
Posterior tibial tendonitis causes pain on the inner side of the foot and ankle. When it occurs, it causes instability while walking. Posterior tibial tendonitis must be managed early on while it can still be easily managed. Otherwise, it can lead to avoidable complications and deformities like adult-acquired flatfoot.
Once consistent inner foot pain is identified, ensure you see a doctor. The doctor will examine your foot and sometimes call for an MRI. While this may sound scary, if a diagnosis of posterior tibial tendonitis is arrived at, know that it can be effectively managed with correct medical supervision.
Posterior tibial tendonitis4 Stages of Posterior Tibial Tendon Dysfunction and Their DiagnosesPosterior Tibial Tendon Dysfunction (PTTD) is a common cause of flat foot deformity in adults. It occurs due to damage to the posterior tibial tendon. The posterior tibial tendon connects the calf muscles to bones on the inside of your foot and is responsible for supporting the arches. When it is affected, the arch collapses, causing pain in the ankle and foot.
Along with the pain, PTTD is also associated with foot and ankle swelling, warmth, redness and pain that worsens during activity, an inward rolling of the ankle, and turning out of the toes and foot. PTTD is progressive in nature, meaning that the symptoms get worse as the condition progresses.
There are four distinct stages with varying levels of symptoms.
Stage 1
Stage 1 is often missed because it comes with little or no symptoms, even though the tibial tendon is injured. A radiological examination will also show nothing. However, it is sensitive to the single-toe raise test.
To perform the test. You’ll begin in a standing position and lift the unaffected foot off the ground. Afterward, attempt to lift onto the toes of the affected foot, which you will be unable to do if you suffer from PTTD. There can also be associated tenosynovitis (inflammation of the tissue surrounding a tendon).
Stage 2
At Stage 2 PTTD, there is a torn tendon that affects regular functioning. Stage 2 can be further divided into Stage 2A and 2B.
In stage 2A, there is a flat foot deformity, a flexible hindfoot but an otherwise normal forefoot. A radiological investigation will reveal an arch collapse deformity. Also during physical examination, the single-leg heel raise test will be negative but there will be mild sinus tarsi (center ankle) pain.
In stage 2B, there is an associated abduction of the forefoot but otherwise remains the same as stage 2A.
Stage 3
This stage is characterized by significant deformation of the entire foot as well as degenerative changes to the connective tissue in the hindfoot. Physical examination at this stage will reveal severe sinus tarsi pain while a radiological exam will reveal subtalar arthritis and arch collapse deformity.
Stage 4
By stage 4, the deltoid ligament is compromised and there are degenerative changes at the ankle joint. Consequently, the flatfoot deformity is worse, usually a rigid forefoot abduction and a rigid hindfoot valgus. A physical examination will reveal ankle pain and severe sinus tarsi pain. As for radiography, it will show an arch collapse deformity, subtalar arthritis, and talar tilt on the mortise view.
When Is Surgery Necessary for PTTD?
In treating flatfoot deformity, conservative means are usually the first line of intervention. Rest, use of custom orthotics, immobilization, ice, medication, and exercises can all help to relieve pain, strengthen tendons, and aid healing. However, if the pain persists even after six months of treatment or there is no improvement, surgery may be necessary.
The surgical approach will depend on the severity of the condition and the level of deformity in the foot. Debridement, reconstruction, and fusion are three common approaches to the surgical management of PTTD when it is deemed necessary.