Posterior Tibial Tendonitis (PTT) is a condition marked by inflammation or irritation of the posterior tibial tendon. This tendon, located along the inner side of the ankle, connects a calf muscle to bones in the foot. Its primary role involves supporting the arch of the foot and helping with foot movement, particularly during walking and standing. PTT is often an overuse injury, causing discomfort and potentially affecting the foot’s structural integrity.
Running with Posterior Tibial Tendonitis
Continuing to run with posterior tibial tendonitis is not advisable. Repetitive stress from running can worsen the existing inflammation and irritation. Persistent activity risks further degeneration of the tendon, potentially leading to a more severe condition known as posterior tibial tendon dysfunction (PTTD). This progression can result in the gradual collapse of the foot’s arch, commonly referred to as adult-acquired flatfoot deformity. Ignoring pain signals and pushing through the discomfort can prolong recovery time and may even necessitate more aggressive medical interventions.
Recognizing and Understanding PTT
Identifying posterior tibial tendonitis involves recognizing specific symptoms. Pain and tenderness along the inside of the ankle and foot, particularly around the arch, are common indicators. This discomfort may intensify during activities like walking, running, or standing, and sometimes after periods of rest. Other signs can include swelling along the tendon’s path, difficulty standing on the toes, or a noticeable flattening of the foot’s arch. A cracking sound or sensation when moving the ankle can also occur.
The development of PTT is linked to overuse, especially in high-impact activities like running. Factors contributing to its onset include a sudden increase in training intensity or mileage, inadequate warm-ups, and improper footwear lacking arch support. Biomechanical issues, such as excessive inward rolling of the foot (overpronation), also place increased stress on the tendon. Other risk factors can involve age-related changes in tendon health, obesity, diabetes, or prior foot and ankle injuries. If symptoms suggest PTT, a professional diagnosis from a healthcare provider is important to confirm the condition and rule out other issues.
Strategies for Recovery
Recovering from posterior tibial tendonitis begins with conservative, non-surgical approaches aimed at reducing pain and inflammation while allowing the tendon to heal. Rest, meaning stopping activities that aggravate the condition like running, is a primary step. Applying ice to the affected area helps decrease swelling and discomfort. Compression and elevation are also recommended as part of the RICE (Rest, Ice, Compression, Elevation) principles to manage swelling. Over-the-counter anti-inflammatory medications, like NSAIDs, can help alleviate pain and reduce inflammation.
Physical therapy plays a significant role in recovery, focusing on strengthening the posterior tibial tendon and surrounding muscles, as well as improving flexibility and balance. Specific exercises may include heel raises, towel curls to strengthen foot arch muscles, and calf stretches. Orthotics or arch supports, which are custom or over-the-counter shoe inserts, can provide stability to the arch and reduce strain on the tendon.
Supportive footwear is also recommended to minimize stress on the healing tendon. Consistency and patience are important, as recovery can take several weeks to months depending on the severity of the condition. In some cases where conservative treatments are insufficient, medical interventions such as injections or bracing may be considered, and rarely, surgery might be necessary for severe, persistent issues.
Resuming Running Safely
Returning to running after recovering from posterior tibial tendonitis requires a gradual approach to prevent re-injury. Before resuming any running, symptoms should have resolved, and adequate strength and flexibility should be regained in the foot and ankle. A progressive return-to-run program is important, starting with walk-run intervals on flat, soft surfaces like a treadmill or track, rather than hard or uneven terrain. The intensity and duration of runs should be increased slowly, by no more than 10% each week, while closely monitoring the body for any pain signals.
Continuing with strengthening and stretching exercises for the foot, ankle, and lower leg muscles is important to maintain stability and support for the tendon. Proper running form should be maintained, and supportive footwear should be worn. Replacing running shoes every 300 to 500 miles, or every 3 to 4 months, ensures continued shock absorption and support. If recommended by a healthcare professional, using orthotics can provide additional arch support and foot alignment.
Cross-training activities like cycling, swimming, or using an elliptical maintain cardiovascular fitness without placing excessive stress on the healing tendon during the early phases of return. Allow adequate rest days between running sessions to facilitate recovery.