Running is a beautiful sport that can fill your life with excitement and a sense of accomplishment.
But nothing can ruin your running experience faster than ankle pain. If you are suffering from inner ankle pain while running, you are not alone.
It’s a common problem among runners, and one of the most frequent causes is posterior tibial tendonitis.
This sneaky condition can cause severe pain, swelling, and stiffness on the inner side of your ankle, which can ultimately sideline you from your beloved sport. But don’t worry, you’re in the right place.
In this post, I’ll dive into the nitty-gritty of posterior tibial tendonitis, what triggers it, how to cure it, and how to prevent it from happening again.
Are you ready to get back on track and take control of your running life? Let’s get started!
What is Posterior Tibial Tendinitis?
Have you ever felt a sharp pain on the inside of your ankle while running? If so, you may have experienced posterior tibial tendonitis (PTTD), a common overuse injury among runners that is often overshadowed by more famous injuries such as plantar fasciitis and ankle sprains. But don’t be fooled – PTTD is one of the most prevalent issues of the foot and ankle, affecting thousands of runners every year.
So what exactly is PTTD? Essentially, it occurs when the posterior tibial tendon, which connects the calf muscles to the bones on the inside of the foot, becomes inflamed, partially ruptured, or torn. The result is tenderness and pain around the bony structure of the inside of the ankle, which can be quite debilitating if not addressed properly.
The Functions
The posterior tibial tendon is truly a hidden hero, working tirelessly to keep your feet functioning correctly during all your activities. But when it becomes inflamed, partially ruptured, or torn, you’ll feel the consequences. Posterior tibial tendonitis is not something to take lightly. In fact, this injury is so common that it affects thousands of runners every year.
When you’re suffering from this injury, you’ll feel tenderness or pain on the inside of your ankle and foot, especially when standing, walking, or running for long periods. Swelling and redness may also occur along the course of the tendon towards the foot. If left untreated, the arch of your foot may collapse, causing pain to shift to the outside of your foot, below the ankle. This can lead to flat foot and cause your toes to turn outwards and your ankle to roll in.
The Symptoms
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.
Symptoms include:
- 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 collapse gradually, 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 a 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.
Additional Resource – Here’s your guide to calf pain while running
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 ruptured. 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.
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Let’s dive deeper into the causes of inner ankle pain and how you can avoid it.
Causes Of Inner Ankle 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:
- Walking
- Running
- Hiking
- Basketball
- Tennis
- Basketball
- 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
Overall, understanding the causes of posterior tibial tendonitis can help you prevent it from happening in the first place. Proper footwear, muscle-strengthening exercises, and listening to your body’s warning signs can all help keep you on the road to healthy, pain-free running.
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 Inner Ankle Pain While Running?
To soothe pain and speed up healing, do the following:
Lower Your Mileage
Cut down on your weekly mileage, and if the 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 these measures.
If not, you should consult your doctor for additional treatment options.
Additional Resource – How To Prevent Ankle Pain For Runners
Extreme Cases
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.
Prevent Posterior Tibial Tendonitis While Running?
There are many measures you can take to reduce your risk of injury.
Here are a few:
Use Orthotics
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.
Additional Resource – Here’s your guide to Anterior Tibial Tendonitis
Stretch Your Calves
Most of the research that reported positive results in the treatment of posterior tibial tendon issues had some form or employed a calf stretching routine.
According to research, the go-to stretching regimen is 3 X 30 seconds of standing calf stretches against a sturdy object, such as a wall, performed twice a day.
Running Shoes
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.
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Strength Train
Besides stretching, there are also a few strength exercises that can not only help soothe your pain but also prevent future flare-ups.
Studies have shown that targeted strengthening exercises can also help prevent posterior tibial tendonitis.
A study published in the Journal of Orthopaedic & Sports Physical Therapy found that eccentric calf muscle training significantly reduced pain and improved function in patients with posterior tibial tendon dysfunction.
Another study published in the same journal showed that adding foot-strengthening exercises to an exercise program improved pain and function in patients with this injury.
These strength exercises 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 as the weakest chain.
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Inner Ankle Pain While Running – The Conclusion
By following these guidelines, you can reduce your risk of injury and get back to running pain-free.
And if you’re still experiencing discomfort, be sure to consult with a podiatrist to help you make the right decisions for your individual needs. Remember, the rest is just details.
Keep running strong!
David D.
