Thirty-nine patients with stage II tibialis posterior tendon dysfunction were randomized to receive either strengthening or stretching exercise in conjunction with wearing an orthosis. The purpose of the study was to compare the efficacy of both exercise strategies, with orthotic use, for the treatment of this pathology. The results of this study indicated that both groups displayed improvements in pain and function over the 12 week study period, with some indication of larger gains in the strengthening group. Nevertheless, no major significant differences were noted between groups in terms of functional outcomes, pain or isometric strength at the end of the 12 week clinical trial.