As runners we all know better than to consult google when dealing with a running injury. I think we all do it anyway. I have gotten some feedback from professionals about my posterior tibial tendonitis (or PTT). However, I feel like it can be helpful to also do my own research. In yesterday’s post I shared that I finally saw a podiatrist about my injury that has been bothering me on and off since last June. After getting some feedback from him, I am ready to really focus on getting rid of this thing once and for all.
Here is what I know about my Posterior Tibial Tendonitis
Typically, posterior tibial tendonitis affects people with flat feet who overpronate. I even found research stating that it occurs most-commonly in obese, middle-aged women with conditions such as diabetes, hypertension, previous surgery, foot/ankle trauma and steroid use. I have been told that I am a neutral runner with high arches. This was confusing to me, but my podiatrist said that having high arches, or a concave foot, can also be a risk factor for PTT. This was news to me.
What can I do to allow the tendon to heal?
After my podiatrist appointment I have been thinking that the main reason it hasn’t healed is due to my work shoes. This may explain why running more or less does not seem to directly correlate with how it feels. That being said, I am going to make sure to keep my mileage really low, not run if it hurts, and support my foot as needed.
My goal is to find some shoes for work that are supportive. Even if I can find a pair to wear once in a while, I can wear a pair of running shoes when I walk to and from my car (which is about 2 blocks). I don’t walk much while I am in my office so that shouldn’t be an issue.
Other ways to heal my posterior tibial tendonitis
A few other ways I can promote healing are nutrition, rest, and massage. I also have a TENS/EMS unit that I will use on that area. I’m looking into collagen which may help with healing tendons, as well as essential oils. (Although I’m not sure there is much research behind either of these.)
My podiatrist asked if I was stretching my calves and I admitted I probably was not doing this as much as I should be. He showed me how he recommends stretching them. I will also work on doing that once or twice a day. This is the one he recommended.
Finally, I think I am going to give orthotics a try. I really, really wanted to avoid this. However, I think I have reached the point where it’s time to give in. They actually won’t be as expensive as I thought because I have good insurance, so if I hate them it’s not a huge loss. I am also a believer that if I can really, truly, build up enough foot strength that I won’t have to use them forever. This will allow the tendon to heal, hopefully.
Foot, Ankle, and Hip Exercises for PTT Injury
I have kept up with my PT work over the past few months. However, I think I need to focus more on the foot and ankle than I did in PT. We were really focusing on the hips, although that included balance. Besides, clearly it’s not working so it doesn’t make sense to continue with the same routine. I came across this blog post with exercises to recover from PTT. Most of the exercises can be found using these links:
Resistance Band Routines to Strengthen Connective Tissue
Glute Strengthening Workout
Arch Enemy
By the way, these exercises are great for any runner who is looking to prevent injury!
Do you use orthotics?
Any other suggestions for dealing with a posterior tibial tendonitis?
How long do you try a recovery routine before switching to try something different (if it’s not working)?
Orthotics, stretching, but also making sure that my bones in my lower leg are set properly have helped. I have a tendency to have a traveling tibia, and that puts my fibula out of whack. Basically, I’m a mess.
Wow, that doesn’t sound like fun at all! I should probably also go to the chiropractor every once in awhile to make sure everythings aligned properly.
PTT isn’t an injury that you can hurry along! I’m sorry to hear that you have to deal with this. It’s been a tough go for you. Hang in there.
Thanks, at this point its bothered me for so long that I definitely don’t expect a quick fix.
I’m a neutral runner with high arches as well. When I went through this, it was because I ran too far right out of the box in a shoe that was very wrong for me. Once I got out of that shoe and gave my foot the rest it needed (6 weeks in the pool) I was able to resume running gradually and pain free, knock wood, never to see signs of post tib strain again (it’s been 7 years).
My advice to you is do some of the stretching, fine. but don’t overkill it either. I think rest and having the bad shoes out of your life will make a huge impact.
Thanks, thats good advice. I just wish I could find the “right” shoes!
Luckily I have never had foot pain, so I have never used Orthotics. My friend has and said they have really helped. Ever hear of icy feet? The are like a sandal you put in the freezer and helps eliminate foot pain. Maybe it is worth a try
Those sound great, I will have to look into them!
I don’t have any experience with this but I still say try to find the cole haan shoes with nike insoles lol. I checked Nordstrom online for you and can’t find it but they are coming up on ebay. there is something else from cole haan called zerogrand that might have the extra cushion but I’m not familiar with it. I just know my old cole haan shoes had the nike cushion (even nice heels) which made them more comfortable and supportive. I will keep looking for you!
Hmm that does sound good. I feel like I need to get shoes I can try on because I really don’t know exactly what i need. It’s not only the cushion thats important, but I need the support around in inside of my foot (which is why flats don’t work well). Thanks for your help!
This is similar to my protocol for PF, although I spend quality time with an ice pack as well. I read that magnesium and fish oil supplements can help with tendon recovery. It sounds like you have a smart plan and I hope it works!
I actually do take both of those supplements- although the magnesium probably isn’t great quality so maybe I will look into trying a better one. Thanks for the tips!
I have really tight calves and my chiropractor has been after me to stretch them more and I am finally listening.
Tendons can take a long time to heal — or at least for me, I’ve found that to be the case. But I also haven’t dealt with that particular type of tendinitis. Not yet, anyway. I do find that shoes can make a big difference to my foot pain. I’ve never tried orthotics, though.
Good luck!
I would definitely say that tendons can take a long time to heel! And it seems that tight calves can cause so many problems.
My chiro has me doing calf stretches and exercises to help strengthen my ankles. Tight calves might be contributing to my knee problems, but I didn’t think that in years past since ITBS focuses on weak glutes.
I guess it’s all connected! I figure calf stretching and ankle strengthening can’t hurt.
Awe, these are so helpful but man oh man I wish so much you didn’t have to deal with this! You’re becoming an expert by default. Hope this issue resolves soon, Lisa. <3
I wish I made the salary of a doctor because sometimes I feel like I know more than them! Just kidding, but you know what I mean.
If you have read any of my blogs, you know that I’ve been dealing with PTT for over a year. Just recently got new orthotics and they actually seem to make it worse. I’m pretty much at a loss. After basically not running at all, except for a 5k once a month, last year ….it did start to feel a little better. Got the orthotics in late January and still can’t run more than a mile in them. I’ve just thrown my hands up and run anyway…without the orthotics. It has been the most frustrating injury I’ve ever dealt with.
I’m so sorry its ben such a struggle for you too. Im going to give the orthotics a try but I have no idea if they will actually help. I hope you find some answers and can finally run pain free!
I do run with orthotics, and I also am in the camp of wondering if that is actually the best, but it is working so I will go with it. I had a stress fracture in each foot prior to using them, and since getting them I made it through a half marathon training cycle without an injury other than your general aches and pains from running a lot, so I guess I will stick with it! I will say that it did take a month or two of running with the orthotics before it started to feel normal–my calves were really tight, which makes sense because I was running in a different way. Just be prepared for that adjustment period if you go the orthotics route. I am going through it again right now actually–I was wearing the orthotic in a supportive shoe, which may have been too much support causing my foot to roll outward. Now I am using the same orthotic but in a neutral shoe, and am dealing with the calf tightness/adjustment all over again. It’s always something, right?
As far as work shoes, I strongly recommend Danskos. They are not the cutest shoe out there, but they are very comfortable and supportive. The classic clog style doesn’t look too bad if you wear them with regular dress pants (i.e. not skinny leg). I recently purchased a pair of Danskos that are more of a flat/loafer style. Not quite as much support as their traditional style, but still much more supportive than your normal dress shoe or flat, and much cuter too! Both of my Dansko purchases have definitely been worth the investment. The things runners do for their feet!! 🙂 Good luck!
Im glad the orthotics are working for you! It really is always something:/ I have neutral running shoes now, so I am hoping I can keep wearing them. Thanks for the recommendation- I will definitely look into Danskos!
Ugh that sucks that you are dealing with this. I have really tight calves which I found out when I went to PT for my stress fracture (and from my research maybe played a part in it besides not good enough recovery) so I’m supposed to do the same calf stretch everyday for a few minutes. As always strengthening my glutes and hips too-thanks for the reminder I need to squeeze in my exercises today.
I don’t know why but its so hard for me to remember to stretch my calves! You would think I complain about this issue enough that I would be doing it all the time. I have always been told I have plenty of flexibility in my calves but I’ll give the stretching a try and see if it helps.
I think you have a great plan and as you know I am kind of doing the same thing for my foot issues, too! Please keep us posted and I hope you can FINALLY get this resolved once and for all. Hang in there, girl!
Thank you so much! I hope you feel better too!
I have not run with orthotics before. I have friends that do though, and it seems to work for them. I know these injuries are frustrating as all heck, but I think your plan sounds solid. I’m just hoping not to spend $$$$$$$ at PT on my injury recovery plan. So far it’s only been $$$, so it better just hurry up and heal while I’m still under budget 🙂
Haha I hear ya! Injuries can be so expensive. If the orthotics work I won’t mind the cost. I really hope they are worth it!
Calf stretching is huge! Tight calves are the route of all evil it seems. I also found that having a chiropractor adjust your feet helps. The bones of my feet seem to slide out of place easily and the posterior tib will flare up because of it.
I’ve actually gone to my chiropractor saying that its felt like the bones of my foot were jammed. Im sure that doesnt help things. I definitely need to be better about stretching my calves!
I am glad to hear there is finally a plan, and I hope changing the work shoes helps so much! I’ve never worn orthotics, but I hope those help.
Thanks, I hope so too!
I have had this before as well and unfortunately you really can’t rush the healing. I also did all of the things you were doing (plus daily icing)but found I really just need to stop running and let it heal.
It does seem like an injury that takes a really long time to heal!
I’m glad you have a better idea of what caused your PTT. I’m sorry that you’re going through this! The exercises sound great – I know that I need to work on my hips, glutes, and foot/ankle strength as well so this is a great resource.
I used to wear orthotics for a while after having PF issues, but I haven’t had to purchase any for a couple years now. They definitely help!
Wishing you the best in your recovery!
Thanks so much! Its good to hear that you were able to transition out of the orthotics. Hopefully I can do the same.
Ugh! I had this once upon a time and it’s a pain. I ended up getting semi-custom orthotics (sp?) for my shoes and it made a huge difference.
Thats really good to know! Im sorry you had to deal with it though- it’s such a frustrating injury!
It sounds like you have a good plan in place. I hope everything helps, and you heal up quickly!
Thanks so much!
I’m so sorry that you are dealing with this 🙁 But I think it’s great that you are being so proactive with a recovery plan for your injury. That’s super smart!
Hopefully this the right protocol! I guess Ill just have to give it a try and see!
Sounds like a good plan. I hope you’re feeling better ASAP. And let me know how the collagen goes if you end up using it.
I actually tried this recipe: http://www.paleorunningmomma.com/homemade-gummy-candy-paleo
I dont know it will be help the healing, but at least they taste good!
This certainly sounds like a nightmare. My PF was merely a twinge-in-passing compared to what you’ve been dealing with. Thinking of you…hoping things heal thoroughly 😉
I feel like most of my other injuries were nothing compared to this! While not very painful, it just won’t go away!
I do wear adaptive orthotics in my shoes. I have high, flexible arches and I overpronate and am prone to plantar fasciitis. The orthotics help give a little extra support, and have been doing well by me. I can’t be without them.
Coming back from injury is hard. I always get a bit of mental block, because I’m always nervous about hurting myself again.
Feel better soon!
Its so hard to come back from an injury! Im so glad the orthotics have helped you!
When I had issues with PF many many years ago, my podiatrist prescribed customized orthotics where they actually made a cast of my feet. It did help with correcting my overpronation. It’s been awhile though since I’ve used orthotics. I wish you a speedy recovery – injuries are frustrating!
Thanks! Im pretty sure I would get custom orthotics. I had them a long time ago but had stopped wearing them. I guess I was given them for a reason!
Hopefully with your recovery plan you’ll heal sooner than later. Be patient and don’t rush the healing process.
Thanks! I hope so too!
So sorry you’re struggling with this injury! Speedy recovery!
Thanks so much!
Sounds like a great plan! I was actually just talking to someone about this yesterday and their work shoes are a common denominator as well!
Why is it so hard to find work shoes that make our feet happy?!
The older I get the more I stretch after running and working ouot. So important. Glad you found a path to healing
Thanks! I am learning how important the recovery piece is for sure.
Ugh, tendonitis is no fun. I hope you get some relief. I am curious to hear more about using collagen as I am hearing more about that as a possible therapy
Thanks so much! And I will be sure to share if I learn more about it.