I plan to resume swimming but that’s very uncertain given the current situation. I typically have people perform the exercises 3-5 times a week. Always listen to your body and intuition. I typically advise no more than a 10% increase in volume per week. Thanks for your article. Do you have any advice for me? I rested it as it hurt to walk and then five days later as in yesterday I went for my 10 mile taper run! So I’m trying to resist throwing out these orthotics LOL. Any and all strength and range of motion imbalances must be addressed. And in the cases of dysfunction one may need additional support. Then, I think from all the stress, exhaustion and lack of sleep, I came down with the flu! In the mean time if it is “sore” then continue to be very proactive with your treatment protocol. Posterior tibialis pain is one of the most common pains in the foot. There is also a very extensive write up on PTTD in the MTA Resilient Runner Program. Hi again Ben – thank you for your advice and guidance. Here are a few points for consideration. I am a nurse practitioner and I have decent notions of anatomy, so I thought it could be PTT or plantar fasciitis (or both?). Training overload. But I would wait to buy anything until after the ultrasound. I’m dieting, but my only exercise now is my at home rehab program, up to like 16 exercises. I agree you do not want to let the pain get out of control or further injure the area. It is loaded with great information. What matters is your ability to enjoy running for as long as you want to. While standing, balance on your affected foot. My left calf muscle is wasting away and I can’t stand on my toes on my left leg. Go slow on the eccentric or lengthening phase. I feel it in the morning as well, but as soon as I start moving it’s fine. Thanks so much! As you eluded in your question how fast a person can taper back up their running distance can vary significantly. Shannen. Hello Now, on the third day, I’m feeling improvement and little to no soreness when walking. I tore my Posterier it’s been 15 months. The most common issue is pain with prolonged exercise particularly running sports. I started with plantar fasciitis a year ago, doctor recommended anti-inflammatory, ice, stretching and rolling the plantar fascia and (oops) stair stretches (dropping the heel from a stair), which then led to a problem at the insertion site of my achilles. Keep us posted! Knee pain won’t disappear overnight, but with a steady commitment, you can soothe and reduce your knee pain, and take steps to avoid it in the future with yoga. Therefore went to both feet on floor with 4kg weight as thought it was less stress than single leg. Females may have hair growth in the gluteal cleft (including around the anus), sometimes extending laterally onto the lower aspect of the cheeks. I would actually take another week off of training and keep with the PT exercises. I was grateful he believed I wouldn’t need surgery though. This is how it affects me: 1. Hi thought I would reply to say I ran the HM yesterday and got a PB too by 5 mins! This is where you can run into issues because if it tears completely then the next onset of pain will likely be from other structures that are taking too much wear and tear to compensate. Thanks in advance. Planning to get a compression socks, not sure which ones are useful as I live in India and the brands , types and sizes are different. I’m a 29-year-old woman, a longtime recreational runner (20-40 miles/week for the last 12 years), and I’ve been training for my second marathon with no injury problems whatsoever, peaking at 50 miles/week with biweekly speed/tempo runs and lots of hills. One last thing – any recommendations for a brace I can wear during the marathon to try and minimize damage? I have been having pain in what I think it my posterior tibial tendon for the past two weeks. Be sure to call the podatrist and follow up with any questions you may have. A common indicator of an advanced condition is known as the “too many toes” sign. Be sure to avoid sharp/stabbing pains, or pain that lingers for long periods of time such as hours to days and any moderate or high levels of pain. If the pain does not subside you may need to be in a walking boot to immobilize the area for a while. Good Luck! Your shoe needs to be comfortable and allow proper mechanics of the foot given your unique body shape and running stride. Any thoughts/help would be amazing. He spent more time with me, and diagnosed a tarsal tunnel injury. Here is a link that briefly discusses the treatment. Greetings from Norway and thank you for a great article. I would seek out a physical therapist that has additional certification in manual therapy. Thanks again – this article and your continued responses to readers’ questions over a 3 year span has been a great resource. Snapping Turtle Symbolism. I am hopeful that the orthotic can help allow you to increase your weight bearing activity. Any discussion on surgery should include a thorough consideration of a person’s health status and the risk vs reward benefit. Aqua jogging can also be a great alternative and has the benefit of hydrostatic pressure which your feet will appreciate. A change in your health or something different else where in the legs and hips. 50 miles is quite a feat. Your medical professional may have another reason to limit some exercises initially. I’ve had a lot of improvement since 5 months ago and am trying to focus on that and be grateful. I have seen a chiropractor, PT, and doctor and have listened to all of them. However, pain should not increase to a severe about above the baseline amount of pain and should not linger for hours and hours. Is it possible to do a full marathon…..you bet! what do you suggest me? Improper progression of training volume and/or intensity can easily lead an overuse injury like PTTD, Achilles tendinitis or other lower extremity injuries. If I follow instruction and rest the foot and ‘am lucky’ and it does not fully rupture, how long do you think it will take to heal and do you think it ‘actually’ will heal, I have my doubts. That only lasts two days. 4. The progression has to be extremely slow. I thank you so much for your answer back in advance and do hope to hear from you soon. A custom orthotic may be necessary to correctly support your foot and insure proper foot mechanics. Maybe I will have to break down and go to a doctor but I really can’t afford it. If as you progress and taper up the weight the pain continues to bother you for up to 4 days post exercise then you need to seek a medial opinion to be sure you are not missing something. What is a healthy discomfort i.e. then i went back home from hawaii after 2 weeks, went and saw a podiatrist that diagnosed me in 10 seconds, he said i had posterior tibial tendonitis. Hey ben i was suffering from posterior tibial tendentious. I have been perplexed as to why this happens. So I couldn’t say how high the risk is only that there is risk and your personal health status and body type would make a big difference on the amount of risk. It’s been a vague pain in my feet/ankles and cramping travels into my calves. It starts at the hips and then work down. By day 9 I was in extreme pain and couldn’t do a single heel raise and had to resort to crutches to get around. It’s … With that being said you are taking the right approach. At this point I agree with you that you should get an MRI. I am a 46 year old female. If you want to attempt a run, it depends on the severity of the symptoms. I certainly neglected some underlying weaknesses, and a few months later (after MANY more ankle rolls in both ankles) a pain in my right arch developed and slowly worsened until I could no longer run. Otherwise stick with swimming. My podiatrist just recommended PT 2 x week for 4-6 weeks and I’m praying it helps! They are responsible for achieving the upright posture when the body is bent at the waist; maintaining the body in the upright posture by keeping the hip joints extended; and propelling the body forward via further leg (hip) extension when walking or running. Again, thank you for your advice and in taking the time in reading over my situation. I’m hoping that I have caught it early this time and am icing it and trying to rest. I really think that was the turning point for me. My hunch is that the noon gun time had something to do with the lack of discomfort since I was thoroughly warm from being up on my feet since 7am. I can still run but every time I do I feel like it aggravates it, particularly if I run hard! Hi Jennifer, Sorry to hear you are having such pain. The calcaneus (heel bone) usually shifts outward at this point. Ol' girl with her hoochie-ass clothes too tight an' her tracks shown' in her scraggly-ass weave with her fake-ass Gucci bag think she cute. Thanks so much for all the info here. The PT needs to start from the lumbar spine and then work down the kinetic chain to address her issues. There really is no reason that both conditions cannot be resolved with a full return to all activities. Foot mobility may also be a factor that needs to be address. Although you will need to progress and train on uneven ground and hills, initially start with level terrain only. After 8 weeks of strengthening and PT my legs are still hurting. Stay focused folks. I am wondering if the use of an arch support/inner sole in everyday shoes would be an option? As far as fitness goes you could try an eliptical trainer or aqua jogging to keep the cardiovascular fitness. Will let you know how it goes!! Santosh from India. [6] Within the Victorian school system in England, the buttocks have been described as "the place provided by nature" for this purpose. I have learned never put limits on people. I am focused on stretching, weight workouts and some biking for now. I have a longitudinal splitting in my posterior tibialis tendon and I really would like to hear from someone who recovered without surgery. I have made it. Eventually it comes back – not only is it annoying and painful, it is also discouraging as I love to run – but this prevents me from accomplishing it. He put her in a boot, prescribed insoles, and required 6 weeks of PT before re-evaluating her. Or evn diagnose what it is? It’s never hurt until Tuesday and it’s the exact place so I know it is this! I went out and bought some arch supports and replaced the insoles in my New Balance walking shoes. Thank you again for your wonderful information. Hip external rotation strength specifically. Thank you again for your willingness to provide advice! He feels that atrophy is hindering me. ouch! A common mistake runners make is to focus only on high reps. When I went off, within two days the pain was back. Am keeping up with the strengthing exercises for it. Expressed as a function of punishment, defeat or assault becomes "kicking one's ass". Thanks heaps Ben. Hi! Proper training is very important to avoid overloading your body. Don’t give up. Still, some mornings were pretty uncomfortable and I had to walk around on my tip toes until the tendon warmed up and stretched out. I have had flat feet since I was a baby . I started running up to 5-6kms (which for years was my minimal distance) in September 2018 and since then was very “aware” of both my feet, of this occasional tightening sensation and always concerned that it would developed further. These are all good questions. You will also want to make sure to work on your calf strength. Day to day pain is at a 1 or 2/10 usually but feels stiff in the foot. Hi Amin, Given that information you really need to focus on the ankle stability or this condition is likely to continue to bother you. I have tried several types of supportive shoes like Asics Gel-Nimbus and GT1000, and most recently the Saucony Redeemer which is supposed to be one of the best. Thanks for the question. I currently have mild PTT from what I think is over training and not helped by a change in trainers. Performing too high of training intensities and volumes. What do you suggest I do? My therapist recommend new sneakers to help, so I was fitted with the Brooks Ghost 10 which I love and have been wearing a few days now with the orthotics inserted. I recently got custom ones, but that seems to be the same problem. Having weakness in the hips can cause the femur to role inwards which can affect the knee and or cause the feet to pronate ( which causes the flat feet). Changing your posture can be an uncomfortable proposition because it makes muscles work and move in ways they haven’t been. Hi Ben – I’m a 3:18 marathoner and I am also running Boston in one week. Putting the new insole in the boot helps extend my time some on my feet. Yes I do think this is a fixable problem. Once the pain is gone work through the suggested exercises and progress your running at 1/2 the intensity and duration you were doing when this occurred. Or if you have other more important races later in the season skip this one. There are 4 things that pop in my head immediately. It is a tough choice. It maybe that you can race without issue or only pain as your consequence. It seems like I never really gave it enough time to rest last time as I was running a lot. If you have access to a hot tub it may be just the trick to relaxing all of those muscles. I have high blood pressure and pre-diabetic… both treated with meds. I am now up to 10k, so Half Marathon goal is 3 months, all being well. Your PT needs to make sure your ankle and foot and in particular, the forefoot and big toe regain full mobility. Your body is telling you that it needs more time to adjust. Recovering from injury can be so difficult. If you have to DNS don’t feel to bad. So be patient, don’t give up and during this time don’t just focus on the foot/ankle focus on you and your body and making the changes you need to be healthy all around. Which of the exercises above would focus on external hip rotation strength? Once the arch has fallen, pain is more commonly felt on the outside of the ankle (as the posterior tibialis tendon has usually ruptured at this point). I have been suffering from this condition for couple of months now, and it occurred right after my recovery from pes anserine bursitis injury (probably I began too much too soon right after the recovery from PAB). 🙂. I’m a pretty active person so this was driving me crazy. She attends dance class, but does not dance. There is no right answer…..I just encourage my clients to be prepared for anything while we do everything in our power to insure a good outcome. I took Monday off and then did an easy 5-miler yesterday; the pain got gradually worse, though never incapacitating, starting at around mile 3 (I would have stopped under normal circumstances, but was running point-to-point and had to meet someone…), and now this morning it’s stiff and sore; walking hurts. fjs.parentNode.insertBefore(js, fjs); Similarly, should I wait to increase distance or speed of my runs until I’m completely pain free? It sounds like my experience since August is exactly like yours with the brace, boot, orthotics, and shoes. I am okay with taking this slowly again just as I progressed from couch to 10k, without the stupidity of what I did in April. Generally, when people talk about someone becoming defensive in the context of a conversation, they are meaning that that someone is engaging in emotionally defensive maneuvers designed to ward off their having to experience some unwanted … Only you will be able to fully answer that question. Thank you for the encouragement and kind words too. Something else I have done in cases that are so chronic is avoid the higher reps and focus on low reps high resistance with good form. You mentioned that you are a soccer player. I have pretty much given up all the outdoor activities that I love and want desperately to return to something more normal soon. Let us know what you decide and how it goes. Running in sports like soccer requires a different running pattern than in long distance running. I would stick with the shoe you prefer and are most comfortable with and something that insures proper foot alignment and adequate support. With clam shells people often use too much resistance so go light resistance and very slow – 5 sec up, 5 sec hold and 5 sec down for 10-20 reps. You should feel it deep behind the trochanter. Best of luck! Kinda like racing in a brand new shoe. if (d.getElementById(id)) return; Hello, I had an MRI a month ago on my left foot and the foot doctor said I have a partial tear in my posterior Tibial Tendon. I continue to have a lot of pain in many different areas of my body, in addition to the PTT. You will also want to look into a rigid or semi rigid custom orthotic to help support the arch. As the run progresses this pain can actually disappear completely. So my questions for you are is how bad do you think I made my feet after my injury, also is there a way where aggressive strengthening and supportive shoes can improve my arch and make me more stable while I run? You get to start running soon 🙂. PTTD is most commonly diagnosed as an overuse injury. She said my case is a “head scratcher”. If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. Sandy….That is fantastic news! (The orthotics have helped some of this), At this rate of walking about 30 minutes a day or less, it’s going to take me 30 years to build any muscle tone. The pain, though initially along the inner side of the foot has now spread to the bottom of the calf as well. If you typically run on softer surfaces, such as dirt or a running track, progress carefully and slowly to running on a harder surface (like concrete). I’ve seen a doctor and a PT for advise, and they concur that it’s most likely some form of PTTD (perhaps without the D). Your body mass will have a direct affect on how the foot functions and how much work it must perform. I’ve decided not to run at all now so I’ll have a full week rest but I’m really worried that ( after all my research) that if this is his condition I’ll end up wending an operation!! Had been experiencing occasional numbness in the left foot on rides. The symptoms come back almost always the day after I run So, I consider to give up running for a considerable period (some 4 to 6 weeks maybe) and meanwhile continue with alternative sports, and here’s my question: What other activities I can get involved as replacement? Make sure you are really working towards addressing the issues that lead to PTT including looking at your hip strength to insure there is no imbalance there which is very common. It will take effort on your part to get it all arranged but it maybe highly revealing. Thanks for any advice you can offer! Lori….thank you so much for the kinds words. My tendons were tight from the start, the pain steadily increased until km 10 and then was static until the end but it radiated up the medial leg, so probably the entire tendon, which I had never experienced before (it was always only my feet). So much work, so much money and effort and it really feels pointless now. Try to loseweight at same rate of increasing weights steadily!!! Look for a good beginner 5k program as a place to start and I wouldn’t run more than 2-3 times a week for now. Good Luck! Thanks for this comprehensive write-up and for your responses to the thread! Have you had an actual video gait analysis to see if there is a small issue with your running form that eventually gets you as the miles add up? I hope that helps! It seems (at my age) every time I improve my fitness something else in the body is becoming the weakest link and I need to get stronger in order to move on. I’m guessing if a physical therapist can help address all of the weakness (at a slow pace) and help me to strengthen my muscles, maybe my orthotics will begin to work as intended. Though flat feet can be an issue for a person so often that is not the whole issue. Guys, I dont know who to turn to! My 15 year old daughter was diagnosed with PTT at the end of July. Whilst running is obviously a no go or a while, is swimming ok? If you’re not entirely sure, don’t push it. Stacy, Glad to hear you are improving. Are there other things I can do to maintain fitness without affecting the PTT – swimming or cycling, for example? At her age there is no reason for her not to be active and pain free. But I would make sure your ankle range of motion is symmetrical/similar to your other side and that the strength is also similar side to side. Thanks for the advice. Also be sure she is very diligent in working on the other aspects of the program especially lower leg strengthening. I could lift heavy boxes. As far as an orthotic goes I would recommend a full length semi rigid orthotic that has a moderate amount of arch support but that also helps control the heel. I am now in shoes that don’t have a lift, but I can’t seem to get rid of the posterior tibial discomfort. Hi Debbie, Yest wearing orthotics in your everyday shoes can be helpful. Additional to that I had laser therapy, shockwave therapy and regular massages with multiple technology. I am already planning on wearing compression socks and KT tape if I attempt the race. He then tells me I need to go into a brace, which I ended up not getting because I felt more unstable in it than out of it. However, the key is to get at the reason why it is developing in the first place. PT and sports med are trying to figure out what is causing it – lumbar or hip issues – but it seems to me that since it began shortly after I started limping all over the place, it’s probably related to gait. 4 weeks should be enough time if you can identify why it started and get the tenderness and inflammation out fast. I feel frustrated because I am pretty sure that this would have been my experience in 2018, had I not deferred in order to rehab myself. (the one he quoted me was $70). All the Best! Thank you for all your incredible information! Since this began and progressed, (not sure if it’s atrophy, PTTD or both), I can no longer walk stairs, squat, sit on the floor as I can’t get back up. I also think you should find a new health care provider. There will likely not be a specific technique that fixes this but a series of things that leads to resolution. “Hmm, I thought, that didn’t sound too good”. Absolutely no running or power walking. If you have done all the above and not seen much change in your symptoms I would advise having it assessed either by a physical therapist or a sports medicine physician to insure something wasn’t missed and to get a more clear picture of the cause of the symptoms. You can always run the race and risk any potential negative outcomes. Obviously you have to build up to a distance like that and so as part of the build up you will know if your feet can handle the distance. Something with a little cushion on top can be helpful. I got an OTC orthotics, which seems too hard, and I think it has developed a Plantaar Fasciitis. Other medical conditions can mimic or be associated with PTTD. PTTD can be very difficult to manage. I haven’t ran at all in the last 3 weeks for fear of deforming my foot. I’ve been trying to help my wife think through treatment plans for what is ostensibly PTTD (we live in the Bay Area).  She is 36, we have a 5 y/o and a 3 y/o, and she has been suffering from bilateral PTTD (we believe) for roughly 1.5 years (since Feb of 2018).  It began in Feb 2018 after she did an intense step/weight/cardio class without her normal insoles, wherein both feet were burning by the end.  The pain moved up the ankle and lingers in both the ankle and up the calf on the internal side (all the way up to the attachment point, to the point where there is bone sensitivity as well as calf tightness/pain).  She is generally healthy (no longer running), 5’4″, and 120 pounds. Â. Hi Butch, Sounds like you are well versed in your anatomy. At least in most cases. Your involved foot and ankle complex is as strong as the other leg. I guess I am still digesting this whole experience. She is also massaging the Posterior Tibial area. Ben, it is unbelievable how cool you are to answer all of these questions…..one more! Based off your description it is difficult to know for sure what may be causing her symptoms. I really want to complete a marathon but we’ll see how things go. And there is no conclusive research that a more cushioned built up shoe is better than a zero drop. I’ve started to feel slight tenderness over the tendon again and am currently icing it after a 5k run. I thought I’d update you with the recent developments. One more question, after starting these exercises, I also seem to have noticed there is less discomfort in the Sinus Tarsi area. And don’t give up! Fast forward eight months (rest, failed the boot, trying to stretch the calves but that usually aggravated the achilles, confusion, physical therapy, acupuncture, chiropractor, massage) and a podiatrist recommended the boot again but this time with a heel lift. My race is this Saturday and I don’t know what to do. In that case you will have to focus on first toe mobility, calf and ankle strength and balance and finally address your glut issue. Will it kill my marathon goals to get some aggressive rest now? Waxing is fast, easy, and hygienic. However, immediately after I stop I can feel it walking. The other physio diagnosed me with weak glutes and tight calves (I know I have tight calves) so I also have been doing strengthening to these areas. However, I have not tried running in the past 3 weeks. from 1905. I’m guessing the best course of action is to ice and rest and see how it feels in a few days… do you have any other advice? Honestly, I never had any foot problems or pain before this injury. Thank you so much in advance! Thank you for your response, Ben. In my opinion you will not be able to rest yourself out of all the aches and pains you have. The two places I would look first is at hip external rotation strength because weakness in this area will cause a person to roll there knee inward slightly which can lead to pronation. Later on, the pains came back everytime i played netball.

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