Faculty Advisor(s)

Kirsten Buchanan

Document Type

Course Paper

Publication Date



© 2019 Matthew Heindel


Background and Purpose: This case report explored the inclusion of barefoot training with intrinsic foot musculature strengthening a patient with stage II posterior tibialis tendon dysfunction (PTTD). Barefoot training and intrinsic musculature strengthening have been effective interventions for other ailments but have yet to be included in rehabilitating PTTD. Therefore, the purpose of this case report was to examine barefoot training with foot intrinsic musculature strengthening within a comprehensive physical therapy (PT) plan of care (POC) for stage II PTTD. Case Description: The patient was a 39-year-old male who presented with stage II PTTD. His goal was to run without pain. The Lower Extremity Functional Index Scale (LEFS), single leg heel rise test, manual muscle testing (MMT), and dorsiflexion (DF) range of motion (ROM) were used to evaluate progress. The interventions included barefoot training with the short-foot exercise, resisted inversion, gastrocnemius and soleus stretching and strengthening, and gluteal strengthening. Outcomes: The patient improved from 49/80 to 71/80 on the LEFS. On the single leg heel rise test, the patient improved from 0 to 18 repetitions on the left. With MMT, the patient improved from a 3+/5 to 5/5 on the left. Lastly, the patient’s left ankle DF ROM improved from 2° to 10° with full knee extension and from 5° to 15° with 90° of knee flexion. Discussion: Barefoot training and intrinsic musculature strengthening within a comprehensive PT POC demonstrated improvement in this case of stage II PTTD. This improvement was illustrated by improvements in LEFS, single heel rise test, DF ROM, and posterior tibialis strength. Future PTTD research should explore barefoot training and foot intrinsic muscular strengthening in a larger cohort of subjects.


The case report poster for this paper can be found here:




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