Therapeutic exercise
Unilateral Heel Raise with Ball Between Heels
Specific variation of the calf raise with an inversion focus, created for rehab of posterior tibial tendon dysfunction (PTTD). The ball between the heels forces active inversion during the raise, selectively recruiting the tibialis posterior — the key muscle of the medial arch.
How to perform
- Starting position. Stand near a wall or chair for light support.
- Step 2. Place a small ball (tennis ball or similar) between the heels — maintain light pressure throughout the exercise.
- Step 3. Transfer the weight onto one leg, lifting the contralateral leg off the floor.
- Step 4. Raise the heel of the support leg over 2 seconds, keeping the ball compressed — the foot should slightly invert during the raise.
- Return. Hold at the top for 1 second and lower over 3 seconds. Perform 10 to 12 reps before switching legs.
When not to perform
- Tibialis-posterior dysfunction in acute phase with severe pain (start with isometric inversion)
- Ruptured tibialis-posterior tendon (absolute contraindication — requires surgery)
- Recent ankle or calcaneal fracture
- Recent post-operative foot or ankle surgery
- Acute talocrural arthritis
- Severe ankle instability without appropriate progression
Medical disclaimer. These exercises are presented for informational purposes only. Always consult your physician before starting any exercise program, especially in case of acute pain, recent injury, or underlying clinical condition.
Related Exercises
Tandem Stance and Heel-to-Toe Walking
Balance training on a narrow base, progressing from static position (tandem) to dynamic gait (heel-to-toe). Functional proprioceptive progression in ankle sprain and tibialis-posterior dysfunction — intermediate between bipedal and single-leg support.
Resisted Ankle Eversion and Inversion with Band
Specific strengthening of the peroneals (evertors) and tibialis posterior (invertor) with an elastic band. In lateral ankle sprain, peroneal weakness is the main predictor of recurrence; in PTTD, tibialis-posterior weakness is the cause. The band allows selective load direction.
Gastrocnemius Wall Stretch
Calf stretch with the knee straight. Restores flexibility of the posterior chain and reduces traction on the Achilles tendon.