Calf & Foot Massages to Relieve PTTD Pain: No Ankle Massagers Needed!

Posterior tibial tendon dysfunction (PTTD) is an overuse injury that affects the tendon supporting the arch of the foot. PTTD causes pain in the ankle and arch, often accompanied by ankle swelling, which makes it difficult to walk, pursue your favorite activities, or go about your day.

PTTD mainly results from overuse, though some people also have biomechanical abnormalities like fallen arches/flatfoot or overpronation that contribute to the condition. Treatment typically involves a combination of rest, physical therapy, and rarely in severe cases, surgical intervention.

One of the most effective, non-invasive treatments for PTTD pain is massage therapy. In this post, we’ll explore how calf and foot massages can address the root causes of the condition, and how to give yourself an effective PTTD massage, using the techniques physical therapists use. Best of all - you don’t need a fancy ankle massager! Read on:

This is what you’re here for, so let’s start with how to self-massage for PTTD. We’ll explain why it works after this step-by-step guide, based on how physical therapists perform massage to treat PTTD.

It may feel counterintuitive, but effective PTTD massage focuses on the calf and arch. Ankle massage and posterior tibial tendon massage are NOT a part of a good PTTD treatment plan (more on this below).

Many PTs swear by massage emollients to create a smooth glide that helps them apply even, deliberate pressure in exactly the spots that need it. A massage balm also helps protect your skin. You can use lotion, but a professional-grade emollient like the Recovery Balm can be worth the small investment.

• Where to massage for PTTD: focus on the arch of the foot. The arch is supported by many small muscles and tendons in the foot itself, in addition to the posterior tibial tendon. Releasing the tension that accumulates in these tissues through massage helps them support the arch better, which, in turn, relieves the overburdened tendon. The area where the posterior tibial tendon inserts, closer to the heel, can be sensitive.

• How to massage:

  • Glide and drag: begin with gentle strokes (effleurage) along the foot’s arch, then apply deeper friction strokes to break up any tightness or adhesions in the connective tissue around the tendon.

  • Grind and press: if you have tightness or pain in a particular spot, apply deeper pressure on the spot with a simple press or a grinding motion.

  • Use the Arch Massager: to make your arch massage easy, use the Arch Massager. The manual foot massager is built specifically for this purpose, by a physical therapist, replicating his soft tissue mobilization work!

• What it should feel like: foot massage can feel soothing and relieving, but you may feel some pain and discomfort. The goal of massage therapy is to increase blood flow, break up problematic scar tissue and release tension in the fascia and muscles, so it doesn’t always feel like a relaxing spa massage when it’s doing its job. Similar to calf massage, pain shouldn’t linger for too long after the massage.

• Duration : Spend about 2-3 minutes on each foot. It's super-quick!

It’s natural to think that you should massage the posterior tibial tendon itself - after all, that tendon is where the tissue damage is, and where you feel pain.

However, don’t massage the posterior tibial tendon itself! Physical therapists only massage the muscles in the calf and foot to address PTTD and never the PT tendon itself. Massaging the tendon can cause further irritation and damage in the already sensitive tendon, and it’s counterproductive.

For best results, perform self-massage every day. It only takes a few minutes a day, but if that’s not realistic for you, aim for at least five times a week. Over time, regular massage relieves pain, significantly improves circulation, decreases muscle tightness, and facilitates the healing process of the posterior tibial tendon.

To shorten your recovery time and make sure your PTTD is fully healed, follow the Alleviate Method. This at-home PTTD treatment philosophy combines daily massages with three other physical therapy modalities:

• Load management with expert PT taping or with a PTTD brace

• Venous return by simply wearing medical-grade compression socks during or after activities

• PT exercises for PTTD, which builds strength and stability throughout your foot and leg, developing long-lasting defenses against flare-ups

When this tendon becomes overburdened repeatedly, it can lead to microscopic tears in the fibers of the tendon, weakening its ability to support the arch. As a part of the natural healing process of these tiny tears, scar tissue and adhesions form in and around the tendon, reducing function and limiting the range of motion.

The condition progresses in stages, with early signs including pain, swelling, and inflammation along the tendon on the inside of the ankle. Many people with PTTD also experience pain in the less-supported arch, or more broadly on the bottom of the foot. The acidic fluid that pools in your foot and ankle not only causes ankle swelling, but also slows down the natural tissue healing process.

With good PTTD massage techniques, you can reduce all these symptoms, and help resolve the underlying problem in the tissue: the tears, scar tissue, and adhesions.

Massage works to address both the symptoms and underlying causes of PTTD. Physical therapists focus on alleviating tension, improving blood flow, and helping the damaged tissue to repair itself. Several physiological changes occur during and after massage:

1. Reduced tension: PTTD can lead to tightness in the calf, foot, and ankle, because all the muscles and tendons are working overtime to compensate for the weakened posterior tibial tendon. Tight muscles can increase the load on the posterior tibial tendon, exacerbating pain and creating a vicious cycle of further damage. Massage therapy helps release adhesions and reduce tightness, improving flexibility and reducing strain on the tendon.

2. Pain relief: massage stimulates mechanoreceptors in the skin and muscles, which can block pain signals to the brain. In plain language, massage can act as a sensation that distracts from pain. With skilled massage, you can get immediate pain relief.

3. Increased circulation: ankle and calf massages help promote blood flow to the treated areas. Increased circulation delivers oxygen and nutrients to the tissues, which accelerates healing and reduces inflammation.

4. Reduced swelling: PTTD massage facilitates drainage. By promoting venous return, massage can move excess fluid out of the foot and ankle, reducing swelling and improving your mobility and comfort. Removing this excess, acidic fluid has an additional benefit: it speeds up tissue healing. [Pro Tip: wear medical-grade compression socks to combat ankle swelling.]

5. Scar tissue reduction: compared to healthy tissue, scar tissue that forms on the tendon is weaker, more susceptible to further damage, and takes up more space, contributing to the over-tight feeling in your foot and ankle. Working directly on the damaged, overburdened tissue through massage reduces scar tissue, and promotes the growth of healthier, more resilient tissue.

While massage is a reliable method for quick pain relief, it plays a crucial role in resolving the root cause of PTTD: massage not only “breaks up” scar tissue and help the tissue heal, it can also improve overall foot alignment and biomechanics, which reduces strain on the posterior tibial tendon.

Daily massage therapy helps you prevent recurrences of PTTD by promoting the health of the entire kinetic chain, giving the tendon the support it needs.If you have early-stage PTTD, think of PTTD massage as a key component in your overall at-home PTTD treatment plan, making sure you're getting the relief that sticks, and avoiding more invasive treatments.

Alleviate was founded by a patient-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With the all-in-one PTTD System, you can easily follow the Alleviate Method to treat your pain and make it stick, without the hassle and cost of traditional physical therapy.

Get all the tools and guidance you need to reduce your ankle pain, and reclaim what moves you - in just 10-15 minutes a day.