Posterior Tibialis Exercises for Marathoners: Build Ankles That Hold Up Past Mile 20
- Marie Whitt
- Jun 22
- 6 min read
I was talking with a runner several weeks back about her right inner ankle pain. And she gave me the full story.
She had a pretty gnarly ankle sprain 4 years ago (where she admitted she didn't rest and jumped right back into running. However she did get xrays done. All clear.)
She did a little physical therapy before training for a half.
Unfortunately afterwards, a weak glute and hamstring strain slowed her down again.
Followed by an unfortunate cancellation of a marathon after being 2/3rds of the way through training because the inner ankle pain, her posterior tib, wasn't having it. Again.
What followed was 3 repeat flares over 3 years.
Because of the same right posterior tib.
That, my running friends, is what we call a pattern.
And as we were talking, alarm bells were going off in my head like, "did she pass this test? What about this one? How's her calf endurance? Single leg balance when her right glute has to do all the work?"
The PT-brain was in overdrive.
And I realized, maybe you're in the same boat, battling the same inner-ankle, poster tib niggle that always pops up at the 20-30 mpw mark.
And just do you know: if that's you, that's not a coincidence. That's your poor ankle asking of help.
So this week, I wanted to give you blueprint, an evidence based checklist you could run yourself through to test whether your posterior tib or any other inner ankle niggles are ready for the increase in mileage in case you have fall marathon training on deck. Obviously, I'll be dropping exercises, too.
So let's hop in.
Inner Ankle Pain From Running: The 3 Strength Tests That Can Predict Trouble
If you're runner with inner ankle or posterior tib niggles, these are the 3 tests you I think you should be passing before your increase your mileage for marathon training.
The Tippy-Top Calf Raise:
Can you reach maximum height in your SL calf riase on the ouchy side? And does it make the other side?
Why this is important: this assessing whether you can access the very TOP of your calf raise which is important for both running endurance and faster speeds. It ensures you have full use and full strength of ALL of your calf muscles which is especially important considering the massive amounts of fatigue you accumulate on your 20 mile long run.
35 Single Leg Calf Raises.
I know, it's a lot. And it's supposed to be. Think about how many steps you take during a long run and on race day.
35 single leg calf raises is an evidence based measurement specific to runners to ensure your calf muscles (including your posterior tib) are ready and prepared to handle the demands of long distance running with decreased chance of accumulating running related injuries.
60-100 Reps of a Single Leg Plyometric:
Now you don't need to do all 60 pogo hops in 1 round! But your ouchy foot does need to be able to do this because again…pretty sure you take more than 60 steps on your long run.
Single leg plyometrics not only build calf strength, but specifically tendon stiffness (aka: stiffness means strength in the "tendon-world"). And while the muscle of the posterior tib can definitely be injured, it's more likely with runners that the injury is at the tendon, rather than the muscle belly. Hence, why not only tolerating 100 single leg jumps is important as it mimics the demands of your running stride, but it also helps to directly strengthen the injured tissue.
Consensus: If your ankle is cranky at all after all 3 of these tests, I highly recommend you put in the work before your 20 miler shows up on your training plan.
How to Build a Posterior Tib Strong Enough for Marathon Training
Circuit:
3 sets each // medium-heavy resistance/ weights
Single Leg Foot on Edge of Step Big Toe TB-hold downs with High Knee
1-2x to fatigue
(TB = theraband, choose a medium-sih resistance)
Paloff Press with Wedge Under Outer Foot
8-10 reps ea direction X medium-to heavy resistance/weight
Injured foot is in front
Single Leg Calf Raise with Outer Foot Wedge
8-10 Reps X medium-heavy weight
the bigger the wedge DOES NOT equal better!
Skater Curtsey Jump
6 Reps ea side
can be done with or without medball/weight
Posterior Tibialis Tendonitis in Runners: Exercises to Stay Injury-Free
Single Leg Foot on Edge of Step Big Toe TB-hold downs with High Knee
Let's work through this exercise in pieces.
THE REASON: I like starting my runners in this "foot plank" position where the front half of your foot is on the edge of the step as it asks your entire foot and calf complex to "turn on". Think gastroc, soleus, post tib, anterior tib, intrinsiic foot muscles, etc.
The reason for the theraband under the big toe is to encourage you to ground through this joint and maintain a relative position of plantarflexion and inversion. Meaning, by grounding your big toe, we're giving your posterior tib the cue to join and help maintain this foot position, especially once you add the balance challenge of moving the opposite knee up and down, resembling your running stride.
Paloff Press with Wedge Under Outer Foot
I love a good paloff press in an elongated runner's lunge position...
TOP TIP: don't be afraid of getting deep into this lunge. I also want 90% of your body weight on the front leg and only 10% on the back. But I realize, with a small wedge on the outer edge of your foot, pushing you to ground through your big toe, you may need more of an 80/20 split (maybe even a 70/30 if you feel really unbalanced). Do what you need to do.
Just realize, as you fatigue, your body will naturally start to "cheat" and you'll shift your weight back on to the back leg. Keep it forward.
So not only does this position resemble your running stride, but it asks your foot and posterior tib to help resist "anti-rotation" forces, meaning your trunk-core gets involved, but so do the itty bitty foot muscles (think of these like the core of your foot). When these teammates understand how to work during your stride and you directly strengthen them with this exercise, your posterior tib is further protected from future injury
Bonus points: highly recommend doing these barefoot or at least with socks on.
Single Leg Calf Raise with Outer Foot Wedge
An oldie, with a twist
THE SECRET: what's cool is that recent research has confirmed that a good, heavy slow resistance single leg calf raise DOES help strengthen intrinsiic foot "core" muscles and the surrounding muscles like your posterior tib.
this is GOOD NEWS because you don't need anything fancy. You just need a heavy weight, good form, and consistency. Now, if you'd like to bias this a little more towards your post tib AND it can handle the extra load, I'd suggest placing your small wedge on the outside of your foot, remembering you want to ground through your big toe.
But don't make this mistakes: the bigger the wedge does NOT MEAN BETTER. Sometimes, it's too much. And it can actually make things ouchy. The lesson: if your foot doesn't like the wedge here: throw it out. Keep it simple.
Skater Curtsey Jump
Plyometrics could be your missing piece
THE KEY: this biggest mistake I see runners make praying that easy theraband ankle exercises will fix all their problems. And it can fix them...maybe even up to 80% like the runner I talked about at the start of this blog.
However I need you to realize...banded exercises are the beginning of the journey and NOT the final destination. Plyometrics like these are your final destination and the spring board to running higher mileage without repeat niggles.
When you're doing this skater jump, please focus on a soft, quiet landing. I want you to pretend you're one of my cats who is hopping onto my counter, looking for treats, and not wanting to get caught.
Note on the medball (or weight plate that I just grabbed off the rack next to me): you do not have to use this, however it can be a fun way to encourage further single leg stabilization and balance and core involvement. The medball does NOT need to be heavy, it just needs to add a little extra challenge. (I typically use a 10-15lb medball. Although you can even use a dumbbell, just don't be klutzy like me and drop it lol).
WRAPPING UP
Remember: your posterior tib doesn't care what your training plan says.
It only cares whether it's prepared for the load you're asking it to handle.
So if your inner ankle pain keeps showing up around the same mileage every training cycle, stop calling it bad luck.
That's a pattern.
Run yourself through the 3 tests above. If your ankle gets cranky, don't ignore it.
Put in the work now so you're not fighting the same battle when your 20-miler rolls around.
Your future marathon-self will thank you.
Dare to Train Differently,
Marie Whitt, PT, DPT //@dr.whitt.fit
P.S. Looking for even more ankle and calf exercises? I've got you covered with my FREE Calf & Achilles Cure. Check it out here:
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