Posterior Tibial Tendon Disease, A Triathlete's Cure

Posterior Tibial Tendon Induced Ankle Pain

I answer a lot of athlete's questions, many from coach referrals, some from various publications like Joe Friel's Triathlete's Training Bible.  I rarely get follow up, especially follow up that's designed to help other athletes.  But Stacy is different and if you have a PTT problem, read on and you may be able to benefit from her experience.

Dear Dr. Post:

Throughout my years of running (and injuries!), I noticed no one ever seems to come back to message boards or threads to update when things actually go well. I wanted to provide a little hope to some folks.

I originally posted back in May of this year (scroll up for the dirty details)* and I truly believe that time and keeping your calves stretched are the "magic potion" to dealing with this obnoxious injury. I did get both softer, "accommodative" orthotics and a pair of rigid ones. The softer ones fit perfectly into my Allbirds and took enough pressure off the PTT to allow me to walk around like a normal person without any pain. That alone was worth the cost, and I even popped them in my recovery shoes after my 18 and 20-mile runs...just to "protect" things. The rigid ones were just as useless this time as they were seven years ago. They're big, clunky, don't fit in any decent running shoes...and they DON'T SOLVE THE PROBLEM. This is what drives me crazy about orthotics and the prescription of them. Unless there is proof that your injury is due to mechanical issues and *absolutely nothing else*, they usually don't help and can often make things worse. For me, I figured out that running on banked sidewalks that actually made my left foot collapse were the culprit. I changed my running routes and voila! - my pain started going away. I got new shoes, but they're still neutral shoes. When I run, I don't overpronate...if anything, I wear pattern shows this.

Anyway, I just finished week 16 of Honolulu Marathon training and am proud and happy to say my PTT has been SILENT for the last five months. Not a peep, not a niggle. Starting in June I began running three days a week, and worked up to four. The deal was, I needed to get through the first three weeks of marathon training pain-free before we could buy our plane tickets to Hawaii. I'm a glass half-empty kind of girl, so I didn't have my hopes up too high. I had no pain, so we bought the tickets. I have two black toenails and a nice, cranky callous on my big toe on my left foot...but no tendonitis. I changed my running to a walk/run and I'm sure that's helped as well...I did that mostly to "ease" back into heavy training (esp during the Texas summer), but somehow it's made me faster, so there you go. I'm actually in better shape now than I have been in years...I've managed to get my hips and glutes strengthened and my core is nice and strong.

Anyway, I just wanted to share that there IS light at the end of the tunnel. This wouldn't have been much comfort to me back in February when I couldn't walk to the bathroom or the kitchen without wanting to cry from the pain, but if I knew then what I know now...and I said this back in May...I would've just sat my butt down on a couch for a month and not moved. And I would've kept foam rolling my calves. Impatience got the best of me, and that was both a huge mistake and a big lesson learned. I spent a lot of money looking for a "quick fix" and being an injury-prone runner, I should know better. Likewise, I'm glad I ignored the orthopedist who delivered the scare tactic of telling me I either had to get orthotics or I would need surgery, and the other orthopedist who told me to stop running altogether because I was "getting older". I'm only 46! Some day I will not be able to run ever again, but today is not that day. :)

Stay strong and stay positive, folks!

One last note...we're taking next year off from marathon training. Halfs are so much more fun, and I have a 4-year old PR that needs to be taken care of. Stay healthy, folks! 


One more resource that may be quite helpful comes from the Academy of Orthopedic Surgeons.  Warning: it's pretty thorough but with patience, you'll find it helpful.

*Stacy's original request.

This is probably going to sound really "out there", it possible...for pressure on the post tib tendon where it inserts into the navicular (that squishy part you can feel) to cause pain and - if done repeatedly (like, up to 35 mpw during a marathon training season, lol) to ultimately cause post tibial tendonitis? As an example, I wear "no show" socks which run right across that area and one of the first "symptoms" I had was a sore navicular, very tender to the touch.

I've been struggling with PTTD since last August, but didn't it didn't get ugly until mile 17 of the Chicago Marathon. I've gone through all of the protocols everyone else has mentioned except a boot or a brace. My PT said a boot would cause immeasurable other problems up the chain and a brace irritated my navicular just having it on so I declined.

I was off running from Dec 1 to Apr 1 (more on that below) but was able to bike pain-free during that time as long as I loosened up my shoe...keep the navicular free. Interestingly, over the last eight months my greatest "healing spurt" took place when we were in Europe in March. I walked 6-8 miles a day, but wore tights or long socks with loose-fitting boots. When we came back, I could walk around barefoot (and my affected foot is super-flat and pronates) with ZERO pain. Went for a run the next day (socks around navicular area, tight-ish shoes) and boom, back to pain in that specific area.

Saw a foot/ankle ortho who told me I needed orthotics (I'm skeptical, but he's saying it's that, stop running, or get surgery) and I have a pair of accommodative orthotics until my pedorthist can get me the rigid ones in three weeks. I've worn them twice for biking and both times was unable to bike more than ten minutes without my navicular hurting and that irritating the rest of the area. There's a really high medial post on my orthotics, and I'm wondering if that is also one of the culprits as I know my navicular is hitting it. Even more frustrating, that slight AM irritation seems to linger through the day even with icing. I didn't bike pain. Biked this AM, more pain. Once that PTT flares up...even just a takes a long time to quiet back down with me. One step forward, two steps backwards. No problems BTW, wearing the orthotics just walking around...not as much impact hitting the medial part of my shoes, I suppose.

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