Dealing with ankle pain is pretty common in runners.
There are many conditions to blame, but when the pain is located inside of the ankle, Tibial posterior tendonitis is often the culprit.
In today’s post, I’ll give you a full overview of the condition, what’s causing it, how to treat it, and, most importantly, how to prevent tibial posterior tendonitis while running.
Let’s get started.
What is Posterior Tibial Tendinitis?
Though not as infamous as plantar fasciitis or ankle sprains, posterior tibial tendonitis (PTTD) is a relatively common ankle injury in runners.
Here’s the truth.
PTTD is one of the most common issues of the foot and ankle.
This injury occurs when the posterior tibial tendon is inflamed, partially ruptured, or torn, causing tenderness and pain around the bony structure of the inside of the ankle.
But, what is the posterior tibial tendon anyway?
Time for anatomy 101.
The posterior tibial tendon is one of the most crucial tendons in your lower legs.
Located on the inside of the lower leg, the posterior tibial tendon connects the calf muscles to the ones on the inside of the foot and.
The posterior tibial tendon acts as one of the main supporting structures of the foot, assisting it to function optimally while walking and running.
The posterior tibialis contacts to produce inversion and help in the plantar flexion of the foot at the ankle.
In fact, any time you walk or run, this tendon locks your ankle in place, which helps keep your foot in a rigid position as you push off the ground.
Posterior tibialis tendonitis typically afflicts only one foot; however, in some cases, it can occur in both feet.
You may also feel pain along the inside of your foot and ankle, where the tendon lies.
You may also notice some swelling in the area.
- Tenderness or pain on the inside of the ankle
- Pain, usually around the inside of the foot and ankle
- Pain is worse when standing for long periods, walking, or running.
- Swelling along the course of the tendon towards the foot.
- Warmth, swelling, and redness along the inside of the ankle and foot.
The Dire Consequences
As the injury gets worse, the arch along the length of the foot may start to gradually collapse, and the pain will shift to the outside of the foot, below the ankle.
As this happens, the foot becomes completely flat as the toes turn outwards and the ankle rolls in
This is what’s known as flat foot—and it’s not the same as in those born with this anatomical structure.
The further your injury exacerbates, the more invasive treatments you’ll need to correct the problem.
Stages of Severity
In general, posterior tibial injury is categorized into four main stages
- Stage 1 – Consists of tendon inflammation or damage, but no change in foot shape. You might also notice that your foot has a mild flatfoot deformity.
- Stage 2 – The tendon starts to become elongated while the arch slowly flattens. As the injury worsens, the arch of the foot starts to collapse; therefore, you can notice flat foot deformity (but not a permanent one).
- Stage 3 – The tendon may be partially or fully rupture. This leads to a more severe flat foot deformity that might be beyond correction, resulting in a condition known as rigid flatfoot deformity.
- Stage 4 – Permanent damage and deformities in the ankle and foot. Not only is the foot affected, but also the adjacent deltoid ligament becomes involved and starts to collapse inward.
Causes Of Pain
Tibial posterior tendonitis is caused by overuse of the tendon or from a specific traumatic impact such as a fall or contact while playing sports.
Common activities that may cause overuse include:
- And other high impact sports
Here are some of the factors that can make you more prone to the condition:
- Gender as it’s more common in women
- Over the age of 40
- Improper footwear
- Weak ankle muscles, especially the posterior tibialis or the intrinsic foot muscles
- Having hypertension
- Having diabetes
- Being overweight or obese
Should you Run with a Posterior Tibialis injury?
This is the first question any runner dealing with this injury wants the answer to.
It’s actually simple: If you’re trying to run through the tibialis tendon, stop.
In fact, if you suffer any type of pain on the inside of your ankle while running, stop training immediately, as logging in more miles can make your condition worse.
The next step is to visit your doctor as soon as possible so you can start the recovery process.
How To Treat Posterior Tibial Tendonitis?
To soothe pain and speed up healing, do the following:
Lower Your Mileage
Cut down on your weekly mileage, and if pain persists, stop running altogether.
You should also limit other sports and activities that cause you pain.
Next, ice the affected area several times per day to soothe inflammation and pain.
Your pain should fade with thee measures.
If not, you should consult your doctor for additional treatment options.
In case of pain persists despite all measures, surgery might be required to fix the damage.
For example, in advanced cases, a doctor may inject a mixture of corticosteroid and local anesthetic into the tendon sheet to help soothe the pain
But the use of such is not recommended as research suggests that they might be associated with a risk of tendon rupture.
How To Prevent Posterior Tibial Injury?
There are many measures you can take to reduce your risk of injury.
Here are a few:
Research has shown that the use of custom-made orthotics may provide extra arch support that can help reduce stress on the posterior tibial tendon.
These devices help reposition the injured foot and reduce the stress on the tendon.
That’s why orthotics not only work great for speeding up recovery but for preventing injury, too.
If you’re looking for more support and a personalized solution, get a pair of custom orthotics from your doctor or physical therapist.
Usually, these tend to be specifically designed for your arch type.
Stretch Your Calves
Most of the research that reported positive results in the treatment of posterior tibial tendon issues had some form, or all employed, a calf stretching routine.
According to research, the go-to stretching regiment is 3 X 30-second of standing calf stretches against a sturdy object, such as a wall, performed twice a day.
To protect your ankles from injury, consider getting a pair of running shoes with plenty of support, cushion, and comfort.
As a guideline, when looking for running shoes, choose the following:
- Support under the forefoot
- A well-cushioned arch
- A wide toe box (since most of the push-off originates from the big and second toe).
You can also consider adding an orthotic to your running shoes.
Just remember to consult with a podiatrist to help you make the right decision.
Besides stretching, there are also a few strength exercises that can not only help soothe your pain but also prevent future flare-ups.
These strength exercise not only target the posterior tibial tendon but other muscles as well, especially the muscles of the calf.
When dealing with overuse injuries, it’s often the case that the affected area isn’t the only problem, but dysfunction in the area surrounding the affected limb can also be problematic.
The human body is, after all, one connected chain—only as strong a the weakest chain.
There you have it!
The above guidelines should set you on the right path toward preventing and treating posterior tibial injury while running.
The rest is just details.
Please feel free to leave your comments and questions in the section below.
In the meantime, thank you for dropping by.
Keep Running Strong.