How I Recovered From a Chronic Posterior Tibial Tendon Injury

Several years ago I dealt with a posterior tibial tendon injury that lasted (on and off) for over a year. During that time I wrote many blog posts about my experience, and now I get questions about what I did to finally get over my injury. I put together some information about my experience and how I eventually recovered and got back to running. While it’s best to seek personal advice from a physical therapist or another medical professional, these are just some considerations for anyone else who may be dealing with this injury.

Estimated reading time: 7 minutes

How I Recovered From a Chronic Posterior Tibial Tendonitis (PTT) Injury

What is Posterior Tibial Tendonitis?

Posterior Tibial Tendonitis (PTT) is characterized by pain around the inner ankle and midfoot, especially while weight bearing. This tendon helps to support the arch of the foot, making it important for runners. The most common cause of PTT is overuse or a sudden increase in activity levels, but foot mechanics and structure also play a role. Symptoms can include swelling, tenderness, or weakness around the area.

If not treated properly, PTT can lead to a fallen arch and flat foot. If it becomes chronic it can eventually lead to posterior tibial tendon dysfunction.

Looking back, I likely got this injury due to overuse. I had done a few races that spring and was not strength training like I do now. As I will explain below, it was likely due to poor hip stability that caused problems down the chain.

Now let’s get into what worked to finally move past my injury!

Working with Professionals

I saw many professionals over the year that I dealt with this. When it first started hurting I went to my chiropractor. He did some soft tissue work and adjusted my ankle. I went a few times and didn’t see much improvement, despite also taking time off from running.

Next I saw an orthopedist at a walk in clinic. Their treatment plan did not sit well with me (wearing a night splint and taking NSAIDS) so I declined both.

A few weeks later I started going to PT. I got my ankle taped, we worked on strength, and I had my running form looked at. This was where I was told I was a “hip person” not a “foot person” meaning my feet and ankles are strong but my hips are weaker. Most likely my hips contributed to my injury. We worked on hip strength by doing alot of standing exercises that also reinforced balance and ankle stability.

I did see improvements from PT for awhile, but once I started running more my ankle started hurting again. By this point I was discharged from PT so I wondered if I needed orthotics to be able to run as much as I wanted again. I went to a podiatrist and he prescribed me orthotics. If you read my blog back then you may remember what a nightmare this was! It took forever to get them and then they gave me blisters and didn’t fit right. I never started wearing them.

By this point I was going to my chiropractor again who was doing dry needling. They also had someone there who did Rolfing and I tried that a few times. These treatments were helpful, but not a full fix.

Eventually I took 6 weeks off from running, worked on my PT exercises, and started doing a full body strength routine. All of these things seemed to help me get back to running pain free!

It’s important to work with professionals when dealing with an injury, but you might need to see more than one person in order to get the help you need.

Wearing the Right Shoes

I tried all different shoes through this process, and eventually landed right back where I started (in Brooks). So for me, I don’t think running shoes were the problem. If you are dealing with PTT it’s worth getting checked to make sure you are in the right shoes. You may also need to consider orthotics.

When my ankle was flared up I had to be really careful about what shoes I wore throughout the day. I found that certain shoes felt better than others. In the summer Birkenstock sandals worked well for me.

Managing Load of the Posterior Tibialis

If I were to go through that whole ordeal again, one thing I would do differently is to take some time off running to decrease pain (which I did) and then take a very careful approach to returning to running, while working on PT. Tendons need to be loaded, but this needs to be done carefully. There is going to be some soreness after a run, but that doesn’t mean you are back to square one. Go slowly, use the run/walk method, and try running every other day. And keep up with the PT!

Rehab for Posterior Tibial Tendonitis

When rehabbing posterior tibial tendonitis the best approach is to work with a PT who can create a plan that is individualized to your needs. If your injury is minor or you can’t see a PT, there are exercises you can do on your own to strengthen your feet and ankles. Don’t forget to look at the hips too, and work on integrating your hip strength and ankle stability.

Nutritional Considerations for Tendonitis

I also looked into nutritional considerations when I didn’t know what else to do for my injury. You can work with a dietitian for individual recommendations. I’ve learned that there is research showing that collagen is helpful for tendon health. I also tried to make sure I was eating enough protein (and enough calories in general) to make sure my body could heal properly.

My #1 Recovery Tool: Total Body Strength Training

I believe that the key to pulling everything together to allow for a return to running was started to lift heavy with a full body strength routine. Prior to this I was doing things like Body Pump, Barre, high rep/low weight exercises, etc. I started working with an online strength coach who gave me a plan and encouraged me to start using heavier weight. I got into a good routine of doing a full body strength workout twice a week that included mobility exercises. I think this helped bridge the gap from PT exercises to being able to run again.

Here are some of the posts I wrote throughout the process:

Sorry this list is so long- it was a long injury! Some related posts are also linked above.

• Are Running Injuries Contagious?
• A Foot Update and 2 Weeks of Workouts
• Rest Now For Success Later
• Resources for Injured Runners
• Foot Progress and Other Thoughts of the Week
• A Week of Some Running and Lots of PT
• 5 Things I’m Working on in (and out of) PT
• The Benefits of Collagen and Gelatin for Runners
• One More Piece of the Injury Puzzle
• What I’m Doing to Put Myself Back Together Again
• June StrideBox, Podiatrist Update, and One Year of my Injury
• The Weekly Wrap: It’s Always Something
• Catching Up: Workouts, Injury Updates, and Life
• Orthotics Update: It’s Not Meant To Be
• Race Envy and the Return to Running

Have you ever had a chronic injury?
What has helped you to overcome injuries?

You may also like:
13 Ways to Make More Time For Running
How Long Do You Need to Train for a Half Marathon?
Create Tiny Habits to Take Your Running to the Next Level

Now it’s time for the Runners’ Roundup! Link up your running and fitness posts below! Join myself, Coach Debbie Runs, Confessions of a Mother Runner, and Runs with Pugs to post your favorite running tips, experiences, race and training recaps, workouts, gear, and coaching ideas.