Question - have you actually had it diagnosed via MRI as tendinitis? Like, are you sure something isn't torn back in there? Tendinitis is a repetitive use injury. If you take a lot of time off and come back and it comes back that fast, I wonder if it's not more serious. I only ask because after everything you mention, there's no mention of an MRI to confirm there isn't a tear somewhere in your lower leg. Not even necessarily back there, but anywhere such that you continually inflame the post tib tendon.

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"Non est ad astra mollis e terris via." - Seneca | rappstar.com | FB - Rappstar Racing | IG - @jordanrapp

Sorry yes I have had an MRI on the lower part of my leg and the ankle. I did show inflammation in the posterior tib tend. My pain is right above the ankle bone. Pain goes away right when I stop activity. No signs of stress fracture on MRI and X-ray.

Weak hips.

You are over bending in the ankle on impact.

When running you should have an equal bend thoughtout the leg joints on impact. You only have ankle and a forward sliding knee. That leads to the problem. The cure is increasing the hip bent through strength and drill.

Good luck

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Technique will always last longer then energy production. Improve biomechanics, improve performance.
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Which foot is hurting currently? It seems to me on the videos that your running gait when shod is quite different than barefoot, especially your left foot. Your left foot is quite "in-toed" when BF, but you are much more out-toed in your shoes. So maybe it IS the shoes.

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Two wheels good. Four wheels bad.

It is the left foot that is in pain this time. I don't run in those shoes much. I run in shoes with mild support. Newton motion, distance s, asics gt2000 which have a lot of support and a pair of mizunos.

I agree with Triathletetoth in that there must be something weak, potentially higher up the chain of muscles in the legs/knees/hips/core/trunk that your overactive posterior tibialis is compensating for. I cannot imagine that thick, "stability" or stiff shoes would help this. Find someone you can work with to figure out what muscle imbalance/weakness/motor control problem your overactive TP is compensating for, and fix that problem. The TP is just a symptom, its not the problem itself.

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Two wheels good. Four wheels bad.

Yea I want to find someone to look at my run mech. If anyone in the tampa area florida area knows of a place to get it done please chime in.

I injured my PTT back in October during some marathon traning and tried all the steps you did. New shoes, insoles, KT tape, roller, etc...Up to this point I've taken periods of 8 weeks and 4 weeks off and I'm in the same boat as you. I got an MRI, it only showed the PTT was inflamed, and I then went to physical therapy during the holiday months. Came back to running, ramped up the mileage a little bit, and boom, right back where I started. Right now I'm starting to run in the 2-3 mile range and I can feel that it's still there. Once it warms up the sensation can go away but not always. I don't have what one would call pain, but I'm confident any real marathon training won't be taking place anytime soon. I'm just hoping to get through the season with some discomfort and then take some real time off from everything...swim, bike, and running.

I'm like you where running was my best leg of triathlon and now I'm just trying to complete runs. Very frustrating!

FWIW, I have a friend who says she finally beat her PTT after a two year battle. Her cure...she got pregnant and took a year off.

Well shoot as a male that getting pregnant is gonna be tough. The year of possible but being the active person I am I would have to do something. Maybe cycling next year and some swimming or aqua bikes might be in my future next season.

Another thing I've tried during the last couple of weeks: I put some Superfeet insoles in my cycling shoes and that has seemed to help give some more support.

When I take time off of running I then cycle something between 200 and 350 miles/week so that's not really resting things. But my physical therapist said cycling shouldn't aggravate it any further. Just one guys opinion though.

I had a problem with super feet in my cycling shoes. They are to wide and my heel doesn't lock down.

Cissus supplement, Ice immediately after runs (stop running when you start to feel the burn, or pain.) Run short loops close to home so it's not a long walk of shame when the pain starts. Get ART treatment, there is a VERY likely chance you have tightness somewhere up the chain, likely in you calves. Do dynamic warmups, and cool down after runs, for me this usually means a 3-5 minute walk. Good luck, I beat my Post Tib tendonitis... Now I have a nagging ITBS issue. Again surely due to tightness upstream. This running thing is always a work in progress for me. One injury to another. Good luck.

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Call these guys. 800+ NFL, NBA and MLB players treated as well as plenty of triathletes. I've know the owner for almost 30 years.

Good luck.

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Mike

I can't tell from the videos how big you are, but I had a bad case of PTT a few years ago. I was around 215 lbs when I got it. Dropping my weight down to 175 pretty much eliminated it.

6' 170 to 180

youve got a pretty noticeable medial stress on both feet at mid stance during your gait. You'll notice the middle of your ankle whips down and inward real quick before you advance your shin forward for toe off. This is exactly where the post tib tendon gets stretched either directly behind or a little over the middle ankle bone. Fix this and prevent this strong dynamic valgus force and you will alleviate the insult to that PT tendon. From here definitely address strength issues further up the chain to attack it from all ankles. If there is weakness then --> is the hip affecting the ankle-knee or is the ankle affecting the knee-hip? Thats one question. Perform slow single leg squat in a mirror or with someone filming you. Watch closely, does your ankle collapse first or does your opposite hip drop and knee go inwards first? Maybe a waist down video might help also.

IMO its the foot mechanics causing insult and resultant re-injury. You may want to try a different set of orthotics, do the research and find someone well-qualified in analysis and prescription. No off the shelf stuff. Proper orthotic support is much more than what the pressure plates at Rite Aid say. Arch length, metatarsal head location etc. There are a number of factors that go into a proper fit and everyone has different anatomical arches. Try a different shoe as well, might be worth the look for something with some more stability behind it. Anything to limit or prevent that valgus stress through the tendon.

Lastly, the damage has been done. The tarsal tunnel has a lot of precious goodies that run through it that can become damaged with the scar tissue/fibrosis. Find a good PT that can assess ankle strength and endurance (not just manual muscle test)in all directions and then perform dural tension tests also to see if its the post tibial nerve aggravated. Just because its not radicular pains doesnt mean its not the nerve.

What exercises "under the sun" have you done? You need to get back to the basics and start with simple intrinsic muscle strengthening. Foot and ankle. A lot of balance type activities, single leg mostly because thats what running is, a series of one legged hops. The proprioceptors are located in the tendons and joints and the PT is really important for dynamic stability of the ankle and foot. If its been damaged then its likely not doing its part from a strength or sensory point of view. The manual work and ART can be beneficial to improve movement but my gut is that its a repetitive insult cause which is preventing the rest of the functions.

A wordy and specific response but if its been so bad youre considering hanging up the shoes then its worth every angle. Hope it helps a little and feel free to PM if youd like!

Cycling can definitely aggravate the foot if theres something wrong in the movement. If you need insoles/more support in your running shoes then you most likely will benefit from them in your cycling shoes too. Might not be as much weight loading through the ankle but theres still some there, so could be worth a try if you want to play it safe.

Sad to say, but time may be your best bet. Serious time off, in a walking boot. All the tape in the world is not going to work. Walking boot + PT for 8 weeks w/o running or biking. I went through this 3 times...basically, lost a season. I'm into duathlons and marathons, so getting this healed was priority. At the end of the day, frustrating as hell. Good luck.

Here are some of the online exercises I have done.
http://www.bidmc.org/...edicine/ForPatients/~/media/Files/CentersandDepartments/Orthopaedic/Sports%20Medicine/Rehab%20Protocols/Posterior%20Tibialis%20Exercises%20092809.ashx

http://runnersconnect.net/...d-improve-hip-drive/

I also do lunges, squats and single leg. I do the calf raises with a tennis ball between my feet. Couple of other hip exercises that I couldn't find an are hard to explain.

I had this in November, knocked me out for 8 weeks and I had to wear a boot. KT tape, ART, arch supports, and massage are just patches that rarely solve the problem. Focusing on strength and balance is the important part. Here are some exercises that helped me recover.

-Dyna disc quarter squats with an arch raise.
Progress into star touches where your opposite foot goes out front, then to the side, then behind

-Heel walks, toe walks, and walking on the outside of my feet while carrying weights (10 pound dumbbells)

- Cross your leg over opposite knee while sitting and then push your foot against your hand to strengthen the inside of your foot
(Great vid of excercises) https://www.youtube.com/watch?v=hgR8FXqcNmk


-Most importantly, 10-20 second hill sprints with high turnover and good recovery in between. (Also the best excercise for IT band syndrome IMOP)

I still do arch raises everyday and keep my runs a bit shorter. From my understanding, once it happens in one foot, it's probably going to happen in the other unless you stay on top of strength exercises.

Right now I'm trying to build up some weekly mileage. What I've been doing is running twice a day (4 or 5 days/week, single runs on the others) but with shorter distances of anywhere from 2 to 3.5 miles max. This plan is going to allow me to get 20-30 mpw while keeping things short. Last week was 15 mpw and this week I'll land around 20 of mostly all slow miles. Then I can try to fit in a few longer run efforts in before my 70.3 in June without going over 30mpw. I know it's not ideal but does it sound reasonable as long as I experience no major pain? As I've said before, I can feel it, but it doesn't HURT...yet.

I'm confident that if I can maintain 20-30mpw between now and June I will be able to nail a pretty good 13.1 run time.

I also have scheduled my first full Ironman in August, since I registered for the Boulder tri-series. I guess worst the case scenario (unless I blow the tendon) is that I get stuck pool running and have some difficult races due to lack of true run training, but if it starts to HURT I know enough now to back off and stop running.

I ran a 3:35 marathon last season running 35 around mpw build up so it's reasonable for me to think I can pull this off if I can just keep running short distances without pain. I know my body will hurt like hell during the later run stages of the IM without the proper long run training but it can be done.

It's a lot of speculation at this point, I don't want to blow my season up and I really want to do well for my first Ironman. As a buddy of mine said, it's better to show up to the start line under-trained than to be injured and watching. Hopefully I find that balance somewhere in the middle of those two options.

One of the best things I did for mine was put supportive insoles in my bike shoes and moved my cleats back about 1/8 inch. I WISH my feet and stride looked like yours. I have wicked flat feet that simply collapse on impact!

Best of luck!

p.s. I have found a love of aqua bike during this journey!

Patti in NJ

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Patti in NJ

I know this is a very old thread but I am wondering if you ever solved the issue. I have had PTT for about 3 years now in my right ankle after having had it for a year in the left. Left completely healed, right just will not.

Thank you.

Nope I'm taking a year off from racing but I have been running. I'm up to 24 minutes at about an 815 pace. I feel it a little from time to time but have been going along well for now. Knock on wood. I think because I was still racing I was pushing myself to much. I have been doing a lot of leg training also. Still bike but not swimming.