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Posterior Tibial Tendinitis
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I've had Posterior Tibial Tendinitis, as athletes are aware this is a terrible injury in that this main tendon from the bottom of the calf down to the foot is used for walking, running, standing..........my PT, said stretching the tendon with specific exercises and RICE with arch support insoles when walking is the remedy, well after about 15 weeks, things weren't improving that much if at all, I was wearing Spenco sandals with the supportive arch at home, orthodontic arch insoles in all shoes.....these were all purchased to tackle my flat feet and tendon that is inflamed and has fluid (showed on 2 x ultrasounds over 15 weeks). Well things weren't getting much better I cut out running and cycling during this recovery period, swimming was fine. So I decided to take my own approach walk around barefoot at home, massage my calf using my Compex muscle stimulator. 3 weeks on, my feet are feeling great, in fact I went for a run on a treadmill today no pain, when I stretch the tendon pain has gone away.............I'm not saying this is a cure, but these 2 things seemed to have fixed my problem. I've gone back to my netural running shoes for walking and running on treadmill.

Comments are welcome, maybe different bodies react in different ways, I'm just glad I'm almost back to normal as this was a horrible injury that leaves the athlete stranded for a long period....I'm back cycling with mileage as well.
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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That is what I’m dealing with. I had a mri and it showed a partial tear. I’m going on 9 weeks without running. Getting very frustrated. It started back in April and have been dealing with it. This year have been a nightmare. Hope it’s gets better or it’s gong to be a long walk for the marathon.
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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mortirolo wrote:
I've had Posterior Tibial Tendinitis, as athletes are aware this is a terrible injury in that this main tendon from the bottom of the calf down to the foot is used for walking, running, standing..........my PT, said stretching the tendon with specific exercises and RICE with arch support insoles when walking is the remedy, well after about 15 weeks, things weren't improving that much if at all, I was wearing Spenco sandals with the supportive arch at home, orthodontic arch insoles in all shoes.....these were all purchased to tackle my flat feet and tendon that is inflamed and has fluid (showed on 2 x ultrasounds over 15 weeks). Well things weren't getting much better I cut out running and cycling during this recovery period, swimming was fine. So I decided to take my own approach walk around barefoot at home, massage my calf using my Compex muscle stimulator. 3 weeks on, my feet are feeling great, in fact I went for a run on a treadmill today no pain, when I stretch the tendon pain has gone away.............I'm not saying this is a cure, but these 2 things seemed to have fixed my problem. I've gone back to my netural running shoes for walking and running on treadmill.

Comments are welcome, maybe different bodies react in different ways, I'm just glad I'm almost back to normal as this was a horrible injury that leaves the athlete stranded for a long period....I'm back cycling with mileage as well.

"my PT, said stretching the tendon with specific exercises and RICE with arch support insoles when walking is the remedy".

Hate to say it my friend, but doing this is possibly why it lingered for 15-17 weeks.

CB
Physical Therapist/Endurance Coach
http://www.cadencept.net
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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When you have this how does the pain present?
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Re: Posterior Tibial Tendinitis [PTinAZ] [ In reply to ]
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What are your recommendations for treating this type of injury? My PT has also recommends stretching and ice, although not complete rest and I've been battling it for 2 years.
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Re: Posterior Tibial Tendinitis [Fishbum] [ In reply to ]
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Fishbum wrote:
When you have this how does the pain present?


When doing any running and also cycling for more than an hour. Also painful 1st thing in the morning. Basically along most of the tendon but more near the ankle.
Last edited by: mortirolo: Jul 28, 18 4:15
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Re: Posterior Tibial Tendinitis [MOPinCO] [ In reply to ]
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MOPinCO wrote:
What are your recommendations for treating this type of injury? My PT has also recommends stretching and ice, although not complete rest and I've been battling it for 2 years.


Lower extremity tendinopathies, especially for runners/triathletes, almost ALWAYS come down to

1) Why is the tendon getting excessively loaded (biomechanically) and addressing it

2) Depending what stage the patient presents.... Unload the tendon initially, then begin to load it progressively.

At times mobilization is needed, at times stabilization is needed.

I don't mean to be vague but these cases present differently with each patient. if you've had it for 2 years, you may need a bit more investigation on why it keeps reoccurring. "Stretching and Ice" aren't high on the list.

CB
Physical Therapist/Endurance Coach
http://www.cadencept.net
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Re: Posterior Tibial Tendinitis [danstu4] [ In reply to ]
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danstu4 wrote:
That is what I’m dealing with. I had a mri and it showed a partial tear. I’m going on 9 weeks without running. Getting very frustrated. It started back in April and have been dealing with it. This year have been a nightmare. Hope it’s gets better or it’s gong to be a long walk for the marathon.

Tendon tears, and/or inflammation are the worst. I've been out of running for over 3 months due to a hamstring tendon tear so I feel your pain. I have a new level of sympathy, for my fellow athletes, now that I've been dealing with it so much. It sucks!!!
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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I've had this twice. Once was a partial tear, and the solution was to be in a walking boot for about 2 months.

Then more recently, I had it without any tear, and the solution has been a combo of rest, calf exercises, and having my massage therapist work specifically on my soleus muscles.

Good luck!
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Re: Posterior Tibial Tendinitis [SBRcanuck] [ In reply to ]
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whilst we try to remedy the problem, to avoid recurrence I believe myself there must be a biomechanical problem with the athlete like myself, ok some say overuse like my PT, I'm not so sure I'm quite good @listening to my body, maybe I wasn't on this occasion.

Is it my hip, knee, ankle.....maybe this can be addressed to fix the problem rather than stretching, RICE etc. I feel I need to see a specialist like a runner who addresses biomechanics. Though I agree with PT that a strong core is essential like good glutes etc. I plan now to include core exercises everyday in my training plan. I'm not one to buy stability shoes these could be good for the short term, but shouldn't we be running naturally rather than with artificial prevention.
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Re: Posterior Tibial Tendinitis [PTinAZ] [ In reply to ]
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When do you usually start strength exercises with this injury? Most things I read or videos I watch don't really give an idea on when to start strength exercises after the injury has occurred. They mention to make sure to do them pain free but is that a good measure of when to begin them?

I believe this just started to flare-up in my right ankle. I can feel a little pain occasionally when I walk around for too long or sometimes when I get out of bed. I know it's still a problem because I definitely feel it when I run. It is not really painful just an annoyance and won't go away for the duration of the run. I want to nip this before it gets any worse. I have tried some band exercises from Youtube videos and never feel any pain or discomfort when I am doing the exercise. I have stopped running so I don't aggravate it even more.
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Re: Posterior Tibial Tendinitis [PTinAZ] [ In reply to ]
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I’ve seen numerous orthopedics and PTs and a few have looked at my run form but been unable to diagnosis the exact biomechanical issue. Some believe I scrunch my toes a bit when pushing off and I definitely have a heel whip on the bad side which likely adds stress to the tendon. Last year the issues landed me in a boot to get it to heal enough so I could try running again.

Do you have any recommendations for places in Denver or Boulder for a biomechanical assessment?

Thanks for your help!
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Re: Posterior Tibial Tendinitis [PTinAZ] [ In reply to ]
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PTinAZ wrote:
MOPinCO wrote:
What are your recommendations for treating this type of injury? My PT has also recommends stretching and ice, although not complete rest and I've been battling it for 2 years.



Lower extremity tendinopathies, especially for runners/triathletes, almost ALWAYS come down to

1) Why is the tendon getting excessively loaded (biomechanically) and addressing it

2) Depending what stage the patient presents.... Unload the tendon initially, then begin to load it progressively.

At times mobilization is needed, at times stabilization is needed.

I don't mean to be vague but these cases present differently with each patient. if you've had it for 2 years, you may need a bit more investigation on why it keeps reoccurring. "Stretching and Ice" aren't high on the list.


Agreed with this. I have had posterior tibialis tendinitis and as a PT, what you were given as treatment was not the best course of action. Seeing that you were (and still are) dealing with this for 15 months tells me that the PT was treating the symptoms and not the root cause. I don't know where you are but ask around and find someone who can help you get to the cause of the problem, solve it and allow you to resume your previous lifestyle. Interview potential PT's and/or past patients to find who is right for you. Best of luck, with good treatment, you should be back at it sooner rather than later.
Last edited by: Minicane: Jul 28, 18 20:01
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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What setting did you use on the compex? Recovery? Dealing with this now and I have a compex sitting unused. really praying this will help.

- depressed triathlete :'(
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Re: Posterior Tibial Tendinitis [bilalm] [ In reply to ]
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bilalm wrote:
What setting did you use on the compex? Recovery? Dealing with this now and I have a compex sitting unused. really praying this will help.


- depressed triathlete :'(


I used Rehibilation mode (Sport Elite model from 2013) - you need single patches along the tendon from foot up to calf I use 4

1 x below ankle 1 x a bit above ankle along tendon, another just before calf and finally another on calf all along the tibial tendon. Like this https://twitter.com/...110689718273?lang=en but on inside

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Re: Posterior Tibial Tendinitis [PTinAZ] [ In reply to ]
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Exactly. It is not a terrible injury, it's just a tendinopathy and the only terrible part here is that your PT didnt realise his/hers knowledge of tendinopathy treatment was actually so low that it instead probably made the pain persist.

From what PTinAZ said I also want to add that you want to limit compression loading in this tendinopathy. I explained it in more detail in this thread.

Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
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Re: Posterior Tibial Tendinitis [mortysct] [ In reply to ]
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Could you give an example of how to *not* put a compression load on the PTT? Reading what you wrote on the Hamstring thread you mention that compression loading is when the tendon wraps around a bony structure and put under tensile load. Since this is the anatomical placement of this tendon how can you load the tendon without it being around the bone? Thank you!
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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Mine has been flairing from time to time. I think running on his have been some of the culprit.

Are you having any luck?
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Re: Posterior Tibial Tendinitis [Fishbum] [ In reply to ]
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Fishbum wrote:
Mine has been flairing from time to time. I think running on his have been some of the culprit.

Are you having any luck?

I can tell my PTT is much better, any pain I feel, I do what the Kenyans do (who don't have access to great Physios) = STOP
I stop pain goes away I run again.

I am currently on holidays with no access to my road bike, so I'm trail running & swimming in lakes. I brought a pair of Salomon's a size slightly bigger (because of the downhills) with a recommendation from a Trail running shop in Lake Annecy, France. I'm feeling no pain @moment, I run up the Le Semnoz and also Rigi in Switzerland, but the beast was Pilatus in Switzerland, I managed to do a bit of sky running which was so awesome, so what I mean is I think it's shoes (stability & fit), running technique I now try to run on my midfoot with smaller quicker steps, calf stretches, one leg balancing exercises to stengthen the tendon, ice each day then warm-hot water.

I personally think this injury for athletes is when biomenchancis are poor and shoes are poor, so a running specialist which I plan to see will help I believe.

It's such a ba.......t injury, I think I'm 90% there now. Also Compex helped which I have mentioned before in this post.
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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Compex?
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Re: Posterior Tibial Tendinitis [Fishbum] [ In reply to ]
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Fishbum wrote:
Compex?

Compex muscle stimulator, I put mine in Rehabilitation mode. https://www.compexstore.com/

Mine is a 2013 model, not sure what models are available now, but these devices are expensive. Maybe if you can test or borrow one firstly.

Here's exactly what I do https://twitter.com/...110689718273?lang=en

Really, stretching the tendon in a calf stretch and one legged stability squats really help the tendon I find.
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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I had post tib issues after an AMAZING race in boston between the stress it was under, slightly different gair and footfall pattern evolving over the last year, and calves that tend to easily get tight.

Took MONTHS to get back to some semblance of normal, lots of time not running, instead doing strengthening exercising, powerhiking, and resting.

Any running seemed to aggravate it. Once it started to feel ok, go a little too far and bam, limping for days.

Been good the last month and a half, slowly increasing volume, but haven't felt anything since late june.
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Re: Posterior Tibial Tendinitis [dfquigley] [ In reply to ]
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dfquigley wrote:

Took MONTHS to get back to some semblance of normal, lots of time not running, instead doing strengthening exercising, powerhiking, and resting.

I'm finding the key now to recovery improvements as the weeks go on, is "Rest and Strengthening Exercises". I'm not sure about power hiking though as you use this tendon with every step you take. It's a critical tendon for the legs!
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Re: Posterior Tibial Tendinitis [mortirolo] [ In reply to ]
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It was worked out with my physiotherapist as well as my coach as the most viable way to keep so e of the liad bearing activity in my legs without aggravating my post tib.

Loading it up within it’s limits I was told should help with the recovery, as long as I didn’t push it too far.

The only thing that bothered it when it wasn’t very flared up was the toe off run movement. When it was flared up badly, then stepping the wrong way could get it.

I could not jog easy for more than a couple km without bugging it but could go power hike for hours with lots of vert with zero discomfort.

Now I am back to running, just getting the volume up.
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Re: Posterior Tibial Tendinitis [Fishbum] [ In reply to ]
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I've got the same problem on the other side of the foot - proneal tendonitis.

No pain at all walking or anything - but quickly gets painful running (like <1km in), and doesn't improve when warm.

Has anyone tried training on an elliptical to maintain some running fitness, while not doing any actual running?

One of the articles linked above suggests glycosamine with chondroitin as a supplement - I found some at my local chemist for ~$30 for 120 tablets, so I'm giving that a go - seems harmless at worst.
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