Looking for some help for my wife here. She is a former swimmer turned triathlete and has been running more in recent years. She’s done Dev’s 100/100 challenge the past couple years, averaging around 70 runs or so. Probably runs ~25mpw throughout the year, peaking around 30 or so. Ran a half marathon in March in 1:45.
She’s signed up for the Steamtown Marathon, and started transitioning from triathlon training to run training about 3 weeks ago. Mileage up from ~25 and closer to 30 now. Usually 6 runs per week, some hills as we live outside of Boston, a weekly tempo run, long run right now in the 8-9 range.
After last week’s long run she had a little tenderness on the inside of the ankle, woke up the next morning and could barely move the foot and couldn’t walk down stairs. It loosened up a little throughout the day, but running was out of the question and walking was uncomfortable. About a week later, it’s still mildly sore, but she’s been able to ride, and walking is relatively normal. But due to lingering tenderness, she went and saw a podiatrist who diagnosed posterior tibial tendonitis. He said the tendon was very swollen, he could create discomfort pressing on it. She feels the worst pain directly below the medial malleolus.
He prescribed some anti-inflammatories, and wants her to wear a boot for 2 weeks and said no swimming, biking or running. This just all seems so severe to me. This wasn’t a case of training through discomfort for a period of time before an injury set on. One day she had a little tightness during her long run, the next day she could hardly walk, now a week later she’s in a boot and can’t even swim or run?
Any one have any advice or insight? Or esteemed forum podiatrist
I think our esteemed forum podiatrist would say that you don’t want to screw around with PTT. If in fact the tendon is swollen, then booting it and resting it for a couple of weeks is probably a reasonable course of action - again, I am thinking about what our EFP would say. Maybe he’ll chime in and agree or disagree with what I’ve said.
My personal PTT issue was resolved by wearing a boot and laying off the S,B,R for a while.
Yeah, it is visibly swollen. I always just think of tendonitis as overuse, not one day you’re fine, the next you can barely walk and a week later you are in a boot.
No S/B/or/R, she’s going to go crazy.
Is complete and total rest the only course of action? Anything she can do in the meantime to assist recovery? Strengthening/stretching exercises, Graston, ART?
I had PTT in the past. After unsuccessfully trying varioous combinations of rest, therapy, cross-training, etc, I decided to just keep running and see if it went away. It did and has not returned. I’m not recommending this for everyone, but I really feel that moderately paced running will keep blood flowing to the affected area and help speed recovery. I would never suggest this for an acute injury, but for a nagging thing like tendonitis, it’s worked for for PTT and knee. YMMV.
I just saw a PT today for this (he’s a runner). Mine isn’t near as severe as your wife (just hurts running), but from what I’ve gathered rest is key. Have her get checked out from someone else. My PT diagnosed some gait issues and muscle imbalances contributed to it. Rest/NSAID’s will not fix my problem.
Acute PT tendonitis is not quite as common as a more gradual onset and chronic picture - just repaired one this morning with an FDL tendon transfer in fact in a reasonably young lady.
Yes, rest is the hallmark for acute treatment, but you really want to get a better idea of what is going on with some imaging (i.e. ultrasound/MRI) to further guide treatment/therapy. She did increase running and started cycling (I presume) so perhaps ensure no glaring bike fit issues (unlikely). You don’t want to set up a chronic issue with PTTD - a serious issue long term for sure.
Acute presumably being her case? Not quite as common, but still occurs. Seemed weird to me for it to come on so suddenly, but glad to hear it’s not a total anomaly.
She was in a lot of discomfort 6 days ago, but was feeling better enough to consider trying to go for a short run. The doctor’s visit this morning was more her hoping to get an all clear. She’s obviously disappointed, but hopefully the fact that she saw some improvement over the last week is a good sign.
Now it’s the boot for 2 weeks and a follow-up. Her bike fit it is solid, she’s been riding for years and actually hasn’t been doing too much riding lately anyway. I am just clueless as to the sudden cause. Her running became a little more frequent, but not to levels she hasn’t done before, as recently as this spring. Wish I had an answer for her, I did read PTT and IT band issues often have a correlation, and she has had those issues, maybe it all started at the top of the chain?
Any recs on additional steps to help recovery after the initial rest? ART? Graston?
Acute PT tendonitis is not quite as common as a more gradual onset and chronic picture - just repaired one this morning with an FDL tendon transfer in fact in a reasonably young lady.
Yes, rest is the hallmark for acute treatment, but you really want to get a better idea of what is going on with some imaging (i.e. ultrasound/MRI) to further guide treatment/therapy. She did increase running and started cycling (I presume) so perhaps ensure no glaring bike fit issues (unlikely). You don’t want to set up a chronic issue with PTTD - a serious issue long term for sure.
This kinda sounds like what I’ve been experiencing and I don’t like the sound of a tendon transfer. How long would that take to recover from? Might have to go get this checked out
If she has also had ITBS and now acute onset PT tendonitis, the 2 things to “look at” would be excessive pronation of the foot (more correctly, subtalar joint) and/or weak hip flexors (in relation to her other muscle groups that is).
@born: you don’t “fix” acute PT tendonitis with a FDL tendon transfer/calcaneal osteotomy. This is for more chronic, long term, nothing else helping cases (she has been suffering for almost 5 + years). VERY long recovery (6-8 weeks non weight bearing, PT, no running for min 3 months and healing still at 9 months out. Not something most on this board would be entertaining or they likely wouldn’t be on this forum in the first place
I don’t know what the definition of chronic is in this situation but mine didn’t suddenly flare up like hers. I started increasing running volume a bit and after a few weeks it would start to hurt a little, nothing to bad that it stopped me running. But then it started to hurt more so I took about a month off. Started running slowly again and within a couple of weeks I noticed a little bit of discomfort. Then went on a 2 month tour around Europe where I only did one run. Got back about a month ago and took it real easy building back into running and I’ve just started to notice it again.
I had severe anterior tibia tendonitus (tendon on front of my right ankle) off and on all last year from running. I had a HM and several tris coming up, so I tried to run through it (made it worse), eventually saw a podiatrist who suggested a heel insert (no help), saw an ortopedist who gave me a cortisone shot (temporary relief). I finally had to take 6 weeks off from running completely. Toward the end, I started running with an ankle brace (the black neoprene kind that goes around your ankle and half your foot with velcro, which you can get at any drug store). The support of the brace really helped alot and within 2-3 weeks of running with it, I didn’t need it anymore. Fortunately, I was able to still swim and bike during the time off from running. I also did aqua jogging and hit the eliptical to try and maintain some running fitness. It does suck but time off from running is the only cure for ankle tendonitis. Hopefully, she can do some swimming and biking. There will always be other races. My advice to her is to start the resting/healing now and don’t push it because it will only set her back further. I wish her luck!
I was just diagnosed myself today based on MRI results. Cause unknown. Came on out of nowhere - never had anything similar. Doc says no running but cycling OK. PT starts on Monday.
No cast or similar immobilization, but my pain is not nearly as severe or regular as your wife’s. My swelling is not visible either. I have much to learn about recovery in a short period of time with my last Kona approaching in less than 3 months now.
I will share my PT’s regimen on Monday, but am guessing it will be relatively gentle joint strengthening/balancing exercises/movements at first with progressive loads. I’d love to hear what others have done/will be doing on the recovery/PT front.
Hip flexors huh? Interesting. When I had IT band issues I was given lots of abductor and glute exercises.
She’s a former DI swimmer with all the accompanying characteristics, super flexible ankles, etc., not sure if that played a role.
After rest, what’s the course of action? Physical therapy? Any reason to consider ART or Graston stuff? I saw in another thread that you replied to, a mention of Kinesio Tape, thoughts?
How about returning to exercise, if it’s a running injury should that be the last sport to return to? Safest to resume cycling or swimming first and maybe the elliptical machine then reintroduce running last?
I had some PTT about 8-9 months ago and I got a set of PowerStep Orthotics that cured it instantly. I had tried the ankle brace, the kinesio tape, rest/PT, etc. and nothing seemed to help (at least for the 2 week time limit that I put on things like that). But I have been wearing the powersteps in both my running and casual shoes 95% of the time, only taking them out to do strides/cool-down barefoot on the soccer field.
Graston/Astym/ART type stuff mostly utilized for chronic issues. You sure don’t want to be rolfing around on an acute tendonitis! I’m a fan of Kinesio taped “methods” if employed properly to rehab an issue while still training (once you get to that level that is). Might not need any PT at all once “rest” clears it up (assuming it does). She was an avid runner before, athlete, and this is likely just a typical overuse training injury. No reason to make it more complicated than that. However, if recurrent or becomes chronic, then you want to figure out what is going on. You are correct on your thoughts: return to swimming first (no flip turns, push off wall easy if at all), slowly to elliptical, run last when cleared.
