Much like other tendon injuries, it presents as a dull aching pain along the front of the ankle or the lower shin, on the outside of the leg. For tenosynovitis, rest and aggressive anti-inflammatory therapy are warranted. Non-Operative Treatment Treatment for stage 1 posterior tibial tendonitis usually involves a combination of: Rest: Avoid activities that bring on your symptoms as much as possible. What is the best treatment for posterior tibial tendonitis? Cold packs. There are other sources of inner ankle pain . . This condition typically begins with pain and weakness of the tendon. Posterior tibial tendonitis and adult-acquired flatfoot deformity can be frustrating problems. Shoe insert or brace. Putting a cold pack on the tendon may reduce pain and swelling. The tibialis posterior muscle originates in the calf . Your arch may eventually fall, leading to a flat foot. For mild cases of this injury, over-the-counter shoe . Posterior Tibial Tendon Insufficiency is the most common cause of adult-acquired flatfoot deformity, caused by attenuation and tenosynovitis of the posterior tibial tendon leading to medial arch collapse. 2017;6(5):e2019e2022. Federal government websites often end in .gov or .mil. This procedure may be delayed 3 months in patients with true stage I disease. Certain exercises can help you regain strength and flexibility in your foot.. Treatment of posterior tibial tendon dysfunction Generally, most cases of posterior tibial tendon pain can be managed with simple treatments such as: Activity modification, including rest from sport Anti-inflammatory tablets such as ibuprofen Physiotherapy to strengthen the posterior tibial tendon and the foot's small muscles. Patients with stage I disease should be evaluated carefully for preoperative structural deformity to choose the appropriate surgical procedure and prevent failure of isolated tenosynovectomy. The excursion of the tendon should be checked intraoperatively. It often gets worse over time or with an increase in activity. Posterior Tibial Tendonitis is a common source of medial ankle pain. Tibialis posterior tendinosis and tenosynovitis are diagnosed clinically. Although this term suggests pathology involving only the posterior tibial tendon, the disorder includes a spectrum of pathologic changes involving associated tendon, ligament, and joint structures of the ankle, hindfoot, and midfoot. 2017;11:714-723. doi:10.2174/1874325001711010714, Deland JT, Page A, Sung IH, O'Malley MJ, Inda D, Choung S. Posterior tibial tendon insufficiency results at different stages. doi:10.1016/j.eats.2017.07.023, Marks RM, Long JT, Ness ME, Khazzam M, Harris GF. Pain and swelling with tenderness of the tibialis posterior tendon behind the medial malleolus is suggestive of tenosynovitis. Gait Posture. o [ abdominal pain pediatric ] Treatment varies depending on the severity of the condition and may include rest, immobilization, medication, and surgery. The site is secure. Treatment for tibialis posterior tendonitis typically includes a period of rest and may require prolonged immobilization and a removable walking boot. In addition, your treatment plan may include physical therapy, which includes strengthening exercises. Nonsurgical treatment can be used at any stage. It can affect your ability to walk or perform certain lower-body movements. Treating Posterior Tibial Tendonitis Treatment for soft tissue injuries often begins with simply resting the area of injury. COVID-19 updates, including vaccine information, for our patients and visitors Learn More. Foot Ankle Int. Posterior Tibial Tendonitis Symptoms, free sex galleries i thought this would be an interesting case to share with, adult acquired flat foot things you should know eva, effective . Tibialis posterior tendinosis, which is degeneration of the tibialis posterior tendon, and tibialis posterior tenosynovitis are the most common causes of pain behind the medial malleolus. People with the condition have: If the examination is unclear or your doctor is considering surgical repair, they may order a magnetic resonance imaging (MRI) scan. But you often do not need surgery unless your symptoms do not get better after trying other treatments for at least 6 months. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Open Orthop J. Here we explain the symptoms, causes and treatment of Tibialis posterior tendonitis. It is most commonly caused by chronic tendinopathy with subsequent functional impairment . Yes, there are exercises that help with posterior tibial tendonitis. Posterior tibial tendonitis is a condition that affects your foot and the inner . Surgery is especially important in young active patients with acute tears. Print. All rights reserved. PTTD can be treated through nonsurgical or surgical methods. A surgeon can do a few different types of surgery to fix this tendon. Treatment may comprise: soft tissue massage dry needling These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. UC San Diego | School of Medicinetoday = new Date(); document.write("Copyright © ", today.getFullYear()); Anterior Tibial Tendonitis is a common condition seen with overuse of the tendon. Rest Rest is the go-to non-surgical treatment to speed up tendon healing in posterior tibial tendinitis. Call your healthcare provider right away if you have any of these: Fever of 100.4F (38C) or higher, or as advised by your provider, Symptoms that dont get better, or get worse, Francesca Torriani, MD Surgical options vary depending on the extent of the condition and include: Posterior tibial tendonitis is a condition that results in pain on the inner side of the foot and ankle. A podiatrist, or doctor who specializes in foot and ankle problems, can diagnose posterior tibial tendonitis by physical examination. Over time, the condition can lead to the arches becoming flattened, a condition called adult-acquired flatfoot deformity (AAFD). How does tibialis posterior . Knee Pain. Once in the later stages, surgery is usually needed, and you may lose some function in your foot. This site needs JavaScript to work properly. This allows the gastrocnemius to act with greater efficiency during the gait cycle [1] Read our, Identifying the Midfoot Region of Your Foot, Tendonitis Symptoms, Causes, and Treatments, How Inflammation of Tendons Can Cause Tendonitis, How Orthotics Can Treat Help Posterior Tibial Tendonitis. This helps in the early healing of the affected ankle. Posterior tibialis tendon surgery. 2021;14(7):1036-1051. 2010 Dec;18(12):1664-6. doi: 10.1007/s00167-010-1194-1. Swelling in the medial ankle. Also known as: tendinopathy, tenosynovitis, enthesopathy, posterior tibial dysfunction, tendinosis. You may also need to limit the amount of weight you put on your injured foot. The risks include excess bleeding, a blood clot, nerve damage, infection, calf muscle weakness, anesthesia complications, and continued pain in the foot or ankle. Siu WS, Shih YF, Lin HC. Over-the-counter medicines can reduce pain and swelling. Tibialis posterior tendinosis and tenosynovitis are diagnosed clinically. PTT is the most common cause of flatfoot in adults. The tibialis posterior is important as it helps to hold the arch of the foot up and stop the foot rolling . Treatment depends on how advanced the condition is. It may cause instability while walking. The symptoms of this condition include pain and swelling. Placing ice over the tendon immediately after completing an exercise helps to decrease the inflammation around the tendon. Tibialis Posterior Tendinitis / Tendinopathy Treatment 165,257 views May 21, 2019 Sports Injury Physio 87.2K subscribers 3.6K Dislike Share Tib Post Tendinopathy can be tricky to treat. Overuse can also damage it. Pain on the inside of the foot and ankle bone (medial malleolus) Spasms of the peroneal tendons on the outside of the foot. poor pelvic and core stability being overweight Physiotherapy for tibialis posterior tendonitis Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence in all patients with tibialis posterior tendonitis. $ 74.97. Reach out to your healthcare provider if you have concerns about the health of your inner ankle. Bookshelf It also gives you stability when you move. It is a key stabilising muscle supporting the medial arch of the foot. What is a tibialis posterior tendinopathy? PTT occurs when there are changes in the tendon, resulting in the inability to support the arch of your foot. This can be a progressive disorder as the tendon can become progressively lengthened from stress making it ineffective or result in tendon rupture. Tibialis posterior tendinitis refers to inflammation of a major tendon that runs through your inner ankle and foot. November 8, 2022 Tibialis posterior tendonitis (tendinopathy) is an overuse injury causing pain on the inside of the ankle. The term "tendinitis" comes from tendin (tendon) and itis (inflammation). If the tendon becomes injured or damaged, it loses its ability to stabilize and support the arch of Unilateral arch collapse with medial ankle bulging and forefoot abduction (too many toes sign) is particularly suggestive of advanced tendon pathology and warrants testing for tendon rupture. government site. Treatment is nonoperative with orthotics and ankle braces in early stages. Symptoms. Another cause is poorly supportive footwear. Posterior tibial tendon tenosynovitis is an inflammatory condition affecting healthy young athletes and can be associated with posterior tibial nerve hyperesthesia. This posterior tibialis tendon is commonly irritated with overuse or training errors with activities including prolonged standing, walking or running. Several surgical choices are available to fix the torn tendon or replace it. Cold therapy If your injury is painful or acute, then rest and apply ice or cold therapy. Posterior Tibial Tendon Tenosynovitis Diagnosed by Point-of-Care Ultrasound. Tenosynovitis of the tendon sheath begins with acute inflammation. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. But you often don't need surgery unless your symptoms don't get better after trying other treatments for at least 6 months. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. When your soleus is strong, you are far less likely to have problems with the posterior tibialis as it will take most of the load in the lower leg. (See also Overview of Foot and Ankle Disorders Overview of Foot and Ankle Disorders Most foot problems result from anatomic disorders or abnormal function of articular or extra-articular structures (see figure Bones of the foot). Posterior tibial tendonitis is classified according to the stage of the condition. The MRI can determine whether the tendon has ruptured, and where. Tibialis posterior muscle The tibialis posterior is a muscle in the lower leg. Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy. Conservative therapy consists of mechanically off-loading the tendon by using custom-molded ankle braces or orthotics modified with a deepened heel cup and appropriate medial wedging or posting. We do not control or have responsibility for the content of any third-party site. 2017 Oct 18;1(4):439-440. doi: 10.5811/cpcem.2017.6.34430. The human body has an incredible capacity to heal after trauma, and if the soft tissue is allowed to rest it will often heal on its own. Many treatment modalities can speed up the recovery process and help you return to activity sooner. In the early stages, treatment may include: Rest from activities that irritate the tendon. This condition tends to occur from overuse, with the elderly typically more affected, due to the wear and tear of tendons over the years. So, it's important to find a doctor who will listen to you and take your symptoms seriously. You may also need to limit the amount of weight you put on your injured foot. Internal Tibial Torsion Pediatrics Orthobullets. and transmitted securely. The .gov means its official. Make use of ankle braces or splints, which will help in immobilizing the tendon. The posterior tibialis tendon is a strong cord of tissue. doi:10.4103/2249-4863.152245, Ling SK, Lui TH. Patients diagnosed with posterior tibial tendonitis may be advised to wear shoe inserts. Bethesda, MD 20894, Web Policies A variety of surgical options are available and indicated for . Use for phrases Posterior Tibialis Tendonitis is much easier to treat in the early stages. The tendon can also be damaged from overuse. This article explains what this condition is, how it occurs, the symptoms to watch out for, and how to treat it. Treatment for posterior tibialis tenosynovitis Treatment for this condition depends on the severity of the tear. They may be given as pills. When the tendon sheath . Treating Posterior Tibial Tendonitis Your doctor may recommend RICE therapy rest, ice, compression, and elevation. It helps maintain the arch of the foot. Treatment Options For Posterior Tibial Tendinitis Conservative treatments effectively mitigate the pain and reduce the swelling associated with the early stages of posterior tibial tendonitis. The initial management of PTT tenosynovitis includes tendon rest and nonsteroidal anti-inflammatory medication and physical therapy. Appointments 216.444.2606 Appointments & Locations Request an Appointment Symptoms and Causes Diagnosis and Tests Posterior tibial tendon dysfunction is the most common cause of acquired flatfoot deformity in adults. Gonzalez FM, Harmouche E, Robertson DD, Umpierrez M, Singer AD, Younan Y, Bariteau J. Skeletal Radiol. Clin Pract Cases Emerg Med. This condition is often caused by an injury to the tendon. HSS J. Please enable it to take advantage of the complete set of features! The initial management of PTT tenosynovitis includes tendon rest and nonsteroidal anti-inflammatory medication and physical therapy. A fall or using it too much can cause the irritation or even tearing of the tendon. 2006;2(2):157160. In the early stage, it mostly involves rest. If you think you may have posterior tibial tendonitis make an appointment right away to see us in our Seattle clinic. Treatment is usually conservative in the beginning. The high-energy late lasers emit a specific wavelength and frequency that helps trigger reactions within the cells. Posterior Tibialis Tenosynovitis. Epub 2012 Aug 9. Treatment of Insertional Posterior Tibial Tendon Dysfunction Treatment of insertional posterior tibial tendon pain achieved by minimising the activity of the invertor muscles and tendons Orthotics with a rearfoot post - There are a number of different orthotic designs available for flat feet. Add to cart. In longer terms cases, appropriate Physical Therapy involving strengthening exercises should heal Posterior Tibial Tendonitis within 12 weeks from the beginning of . You may also need to limit the amount of weight you put on your injured foot. J Am Acad Orthop Surg. 2000-2022 The StayWell Company, LLC. Tibialis anterior tendonitis (tendinopathy) is the most common injury to cause anterior tibialis pain, but a tibialis anterior tear, known as a tibialis anterior muscle strain does occur on occasion. This area of the tendon is particularly prone to problemsit exists in a "watershed zone," where the blood supply is weakest. Pain may last longer than 3 months even with early treatment. HHS Vulnerability Disclosure, Help Pain often is localized to this portion of the tendon (primarily in stage I disease). Are there exercises that help with posterior tibial tendonitis? Stage 1 through stage 4 indicate increasing deformity (abnormal shape) of the foot as the condition progresses: As these stages progress, more extensive treatments are needed to correct the problem. Posterior tibialis tendon dysfunction is the most common cause of acquired flatfoot deformity in adults. Posterior Tibial Insufficiency Treatment Leg Realignment. Jonathan Cluett, MD, is board-certified in orthopedic surgery. It runs behind the ankle bone on the inside of your ankle (medial malleolus), across the instep and attaches to the bottom of the foot. Posterior Tibial Tendon Dysfunction: An Overview. Surgical synovial dbridement is performed early (6 weeks) in patients with enthesopathies (seronegative disease). Cold Laser Treatments for Posterior Tibialis Sprains. Varying degrees of pain are felt around the ankle. You should avoid any activities that cause pain and swelling. A posterior tibialis tendinopathy (PTT) is when damage occurs to one of the tendons that runs on the inner side of your ankle. The tendon from this muscle runs behind the inside bone on the ankle (called the medial malleolus), across the instep and attaches to the bottom of the foot. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Posterior tibial tendon dysfunction (PTTD) is a painful condition that affects the foot and ankle. and raise your heel. Deland JT. Like a leg cast or walking boot, these devices can help protect the tendon as it heals. Here, it attaches to the bone of the inner side of the foot, just next to the arch of the foot. Verywell Health's content is for informational and educational purposes only. 2010. It can also show inflammation surrounding the tendon. Surgical treatment of posterior tibial tendonitis is controversial. Or they may be put on the skin as a gel, cream, or patch. Treatment of posterior tibial tendon dysfunction must include: Restoration of mobility and stability of foot and ankle Straightening of tibialis posterior muscle Foot intrinsic exercises to reinforce arch of the foot Ankle dorsiflexion exercises Big toe extension mobility and strengthening Mobilization of the posterior tibial tendon Putting a cold pack on the tendon may reduce pain and swelling. Resting and a brace or cast are non-surgical treatment steps. This is an injury that left untreated can turn in to something bigger. Like a leg cast or walking boot, these devices can help protect the tendon as it heals. Less commonly, foot problems reflect a systemic read more .). J Am Acad Orthop Surg. Posterior tibial tendon dysfunction. What is tibialis posterior tendinopathy? Your doctor may recommend RICE therapy rest, ice, compression, and elevation. Arthrosc Tech. Epub 2019 Feb 19. PMC Advert Tibialis posterior tendinopathy symptoms The initial treatment of posterior tibial tendonitis is rest so that the tendon can heal. The types of surgery used to treat this condition include lengthening the Achilles tendon, tenosynovectomy, tendon transfer, osteotomy, and fusion. Pain is felt on the inside of the ankle which may radiate under the arch of the foot. The tibialis posterior tendon is an important structure that works, with other structures, to hold up the arch of the foot. By Jonathan Cluett, MD Tibialis posterior tendinopathy is swelling within the tendon of this muscle. The link you have selected will take you to a third-party website. Anti-inflammatory medication may also be recommended. Knee Surg Sports Traumatol Arthrosc. Cold packs. 1 The first few weeks are hallmarked by sharp pain, and the pain gradually subsides over the course of a month or so. Unfortunately, even normal walking may get in the way of allowing the tendon to heal adequately. Push up on to the balls of your feet, hold for a second at the top of the movement, and return slowly to the . The tibialis posterior tendon may become damaged or inflamed. MRI or ultrasonography can confirm a fluid collection around the tendon (indicating tenosynovitis) or the extent of chronic degradation or tearing to the tendon with associated tendinosis. Added stress will prolong the healing process. PTT tenosynovitis is a recognized entity no longer confused with an ankle sprain. You may notice it more when you use it, especially if a repeated motion like swinging a hammer or a tennis racquet caused it. Eva Umoh Asomugha, MD, is a board-certified orthopedic surgeon who specializes in all conditions involving the foot and ankle region. Pain and swelling with tenderness of the tibialis posterior tendon behind the medial malleolus is suggestive of tenosynovitis. Strengthening and stretching exercises. The posterior tibial tendon lies immediately behind the medial malleolus. A calcaneal spur is also noted. Tibialis posterior tendonitis is a condition defined by tissue damage and swelling in the lower portion of the leg and ankle area, causing pain and discomfort. The left tibialis posterior tendon measures 8.7 mm compared to 4.7 mm on the right side. This condition is often caused by an injury to the tendon. Exercise 3 - Calf Raise. Before Call your healthcare provider right away if you have any of these: Fever of 100.4F (38C) or higher, or as directed, Symptoms that dont get better, or get worse, Monday Friday, 7 a.m. 5 p.m. 2016 Feb;474(2):588-93. doi: 10.1007/s11999-015-4581-6. Treatment may include: Rest. Bubra PS, Keighley G, Rateesh S, Carmody D. Posterior tibial tendon dysfunction: an overlooked cause of foot deformity. You may also need to limit the amount of weight you put on your injured foot. The first stage of posterior tibial tendonitis involves swelling of the tendon on the inner side of the ankle. As the condition gets worse, the foot's arch can flatten, and the toes begin to point outwards. Always follow your healthcare professional's instructions. 2009;29(1):17-22. doi:10.1016/j.gaitpost.2008.05.012. Shin Pain. The posterior tibial tendon runs from the calf muscles, down the inside of the ankle, and to the bones of the foot. The PTT has a hypovascular zone 40 mm proximal to the insertion of the tendon and 14 mm in length. Palpation of the tendon with the foot in an inverted plantar flexed position with applied resistance is usually painful. Johns Hopkins Medicine. Tenosynovial fluid as an indication of early posterior tibial tendon dysfunction in patients with normal tendon appearance. Epub 2010 Jun 16. Unable to load your collection due to an error, Unable to load your delegates due to an error. Overuse can also damage it. 2022 Dotdash Media, Inc. All rights reserved. Supple KM, Hanft JR, Murphy BJ, Janecki CJ, Kogler GF. This reduces pain, inflammation, and swelling. Enter search terms to find related medical topics, multimedia and more. Normal standing, walking, and standing on the toes become difficult. Posterior Tibial Tendonitis Symptoms. Semin Arthritis Rheum. The posterior tibialis tendon runs along the inside of the foot. Physical therapy for posterior tibial tendonitis (PTT) can help you regain normal foot and ankle range of motion (ROM), strength, and mobility. Following are steps and exercises for non-surgical recovery of posterior tibial tendon dysfunction. NSAIDs (nonsteroidal anti-inflammatory drugs) are the most common medicines used. The diagnosis is usually based on symptoms and an examination and sometimes imaging tests. These devices can help protect the tendon and reduce swelling. Specific wavelengths help decrease inflammation and pain. In acute episodes, if they are managed correctly with offloading, non-impact exercises, and the appropriate footwear. J Family Med Prim Care. These orthotic devices are cushions made of foam or gel that are placed in the shoe of the affected foot. Knee Surg Sports Traumatol Arthrosc. Tibialis posterior tenosynovitis with synovial effusion is responsible, in this case, for medial foot swelling and pain. Treatment of any associated conditions such as tibialis posterior tendinopathy is also important. They may also ease pain. Severe tears of the posterior tibialis tendon may need to be kept from moving. This results in flattening of the foot. Physical Therapy for Posterior Tibial Tendonitis, Medial Malleolus Fracture and Broken Ankle Treatment, Posterior Ankle Impingement Syndrome: Symptoms, Causes, and Treatments, Bimalleolar and Trimalleolar Ankle Fractures, Foot Pain Causes, Treatment, and When to Seek Help, Achilles Tendon Pain: Symptoms, Causes, and Treatments. For instance, a fall can tear the tendon. Palpation of the tendon with the foot in an inverted plantar flexed position with applied resistance is usually painful. Treatment Of Posterior Tibialis Tendonitis/Rupture : Conservative treatment; As with most cases of soft tissue injuries the initial treatment is - Rest, Ice, and Protection.. Rest: In the early phase the best is to avoid all activities that induce pain. It is one of the most important tendons in your leg. Treatment may include: Rest. Several surgical choices are available to fix the torn tendon or replace it. However, it's best to contact your healthcare provider before trying any exercises to see which ones will work best for you. Foot Ankle Clin. Stage II, the tendon begins to become elongated, and the arch gradually flattens. It helps maintain the arch of the foot. 1992 Oct;22(2):106-13. doi: 10.1016/0049-0172(92)90004-w. Mosier-LaClair S, Pomeroy G, Manoli A 2nd. Posterior tibialis tenosynovitis is when this tendon becomes inflamed or torn. All rights reserved. Tendonitis is a common foot problem as our feet take tremendous amounts of stress and rarely get to rest. verify here. As one of the primary supinators of the foot and ankle, it helps to support and control the medial longitudinal arch of the foot. Weakness in the foot. Stop running if you are having SHARP pain Only use ice to inhibit pain, otherwise use heat to loosen tight muscles Don't take anti-inflammatory drugs and run A foot and ankle specialist can guide you in your diagnosis and recovery process. Description The Tibialis Posterior is located deep in the posterior compartment of the lower leg and situated between the Flexor Digitorium Longus and the Flexor Hallucis Longus. 2012 Sep;17(3):399-406. doi: 10.1016/j.fcl.2012.06.002. You should avoid any activities that cause pain and swelling. However, these can vary depending on your age, general health, the type of surgery, and your foot's anatomy. Most episodes of posterior tibial tendonitis last about 4 to 6 weeks. The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. van Sterkenburg MN, Haverkamp D, van Dijk CN, Kerkhoffs GM. Geriatr Orthop Surg Rehabil. Treatment for this condition depends on the severity of the tear. Severe tears of the posterior tibialis tendon may need to be kept from moving. not collapsed onto the ground!). Tibialis posterior tenosynovitis is inflammation of the protective covering around the tendon (called the tendon sheath). Please confirm that you are a health care professional. sharing sensitive information, make sure youre on a federal The tibialis posterior tendon starts at a muscle in the calf, runs down the inside of the lower leg and then travels around the ankle before attaching to bones in the arch of the foot. Stand sideways on to a wall, with both feet flat on the floor and your arches held in a good neutral position (i.e. Regents of the University of California. Posterior Tibial Insufficiency Treatment Leg Realignment. Putting a cold pack on the tendon may reduce pain and swelling. Foot Ankle Clin. The inflamed tendon may be painful and swollen. Origin The origin of the muscle is [1] : Proximal postero-lateral aspect of the tibia. Apply cold packs on the most painful area of the posterior tibial tendon for 20 minutes at a time, 3 or 4 times a day to keep down swelling. Saint Lukes Concierge: 816-932-5100, Understanding Posterior Tibialis Tenosynovitis. Classifications in Brief: Johnson and Strom Classification of Adult-acquired Flatfoot Deformity. Over time, the pain becomes severe, with painful swelling behind the medial malleolus. Leg cast or walking boot. For instance, a fall can tear the tendon. Treatment may include: Rest. It then turns under the inner side of the ankle. Once in this phase, you probably will not be able to perform a single-leg heel raise at all. 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