Posterior Tibialis Tendinitis

My Posterior Tibialis Tendinitis woes

started with it a couple of weeks before Xmas

rested for a few weeks went to physio and had ultrasound/massage

been self massaging/heel lifts/1 leg balancing (standing on one leg)

back running once a week image (only managing 10k in this one session) the next day i have the same weakness in ankle

Don't feel like i'm any further forward.  V frustrating. Am i doing something wrong? Is it just a case of being patient and x training until it clears up?




  • you are probably still doing too much. you had rested for a few weeks and then went out and did 10k? you need to do much shorter distances, i think. a mile at most...

  • oh ok - so if I go out on Sunday and try a mile and then see how my ankle is after that?  also have physio appt again tomorrow.



  • i think you need to take it slowly. are you still getting pain when you walk? or after you have walked?

  • very mildly - it's more if I twist my ankle which causes the issue - which would show that there is still weakness somewhere.

  • yup. and while you still have weakness, running is going to stress it further. i know it's hellish but you have to concentrate on strengthening the ankle and also the support further up - eg your glutes.

  • Thank u very much. I will start strengthening my glutes too. Think I'm just going to be sensible and go very easy. It is hellish but suppose it could be worse.
  • Hi been to physio, he basically said the same to me - lower mileage and build up slowly.  He said its a balancing game as to what my ankle can handle whilst im in rehab  - told me not to stress about losing mileage I've taken so long to build up as I will get there again and won't take too long but stressed the imprortance of building up slow.

  • there you are you see. you got the same advice from some random woman off the internet at no cost to you image

  • Yup. Thank you.

    Can I ask if this plan worked for you? So after some time resting did you go for a short run and then build up from there?
  • Yes and no. I was a brand new runner when I got PTT. So physio recommended I get more supportive shoes. And when that still didn't work I ended up with orthotics. I think PTT is usually a sign of overuse and in my case it was because I was doing far too much with a wonky gait and weak glutes.
  • Thanks for info

    Just done 2 miles. Congratulated myself for stopping at that point but also felt tired anyway so didn't mind too much.

    Will see how my ankle is tomorrow then rest a couple of days then go out and do the same again.
  • Hi samsunguser, its good advice from CM. You've got to take it easy with PTT. I've been suffering since a half marathon in September and done almost no running since. Went to doctor and got referred to NHS physio  who started me on exercises for weak gluteus medius and arch strengthening while the PTT heals. I had noticed myself that sometimes my knees knocked when running which is a sign of weak glutes & hip dropping. I only started back with a little running in the New Year and even then had a bit of a setback a couple of weeks ago. After another 10 days off I've only just done 1 minute of light jogging in the middle of a 10 minute walk this afternoon. Not going to risk any more than that every few days at this stage. 

  • Hi there. Thanks for your input. Since sept! How are you dealing with that? The reason I ask is that I'm quite depressed with mine and only been 6 weeks. After my two mile run earlier I experienced pain in my ankle just whilst walking and I started to cry. Pathetic I know.

    Anyway thought I'd share.
  • I understand! You really need to concentrate on strengthening and also look for the cause of the weakness / instability. Do you know what that is? Even if you strengthen the ankle, if you have an underlying imbalance or instability it will keep coming back. Mine is a wonky pelvis (I have scoliosis) and weak glutes. You will find that there is a root cause of this which may be much further up your legs than you imagine! Have you had someone analyse your gait? Not necessarily in a running shop - perhaps a podiatrist?
  • Yes it's very frustrating. Mine used to come on after just 10 mins of running (almost exactly) then I'd be limping for the next day or two. I'm trying to take some positive things out of it. (1) I've learned that only increasing milage by 10% a week is not just for other people (2) The glutes weakness identified by the physio is being corrected by the exercises and will make me a better runner afterwards (3) I'm taking the opportunity of having to return slowly to try and correct other gait issues - like trying to land more front/mid foot than heel striking. Tendons can take months to heal and I keep telling myself that I may end up a better runner afterwards if I learn all the lessons.

  • Hello and thanks both for replies. Thought I was going out of my mind yesterday I mean there are plenty people worse of than me and there I was being self pitiful. Think it just overwhelmed me. Also I find a release of my anxieties through runniing and without this it just makes me even more anxious.

    I will start strengthening my glutes. I saw a pod a few years ago and he too suggested glute strengthening. I'm trying to be positive too and am listening to advice.

    Thank you and wish you both we'll too.
  • samsunguser: do as the physio says! You really need to REST the tendon. Buy some over-the-counter orthotics that will give you arch support  - to use in your everyday shoes, for when you're just walking around in daily life. Go swimming. I know (very, very well) that it's not the same, but it's better than no exercise. Also consider something else positive you can do (I've found that volunteering at my local parkrun has really helped when I've been unable to run due to injury). AND, this time of year, if you've usually been out in daylight running and you've lost that, consider whether there might be an element of SAD in the depression - you may need to get an SAD light and use that.

  • Sorry to sound so negative here image but the only thing that worked for me with PTT was surgery.  Prior to the surgery, I came back slowly doing loads of stretching, but once I got to running for 1 hour, the pain started again.

    Frustrated and cheesed off having forked out loads with physio fees, I saw a sports specialist surgeon who operated on me.  After the rehab (8 weeks), I was back and no problems with it since.

  • SumoSue, do you know what the surgeon actually did? Was it above the ankle bone or below?

  • The scan I had prior to surgery showed there was a small tear in the tendon caused by overuse rather than a trauma.  Re: the ankle bone not sure but the scar goes from below the ankle bone, around it and finishes just above the bone. 

    Hope this helps.

  • I tore mine (partial tear) in a cycling accident and have been in an Aircraft PTT brace for three months, but no surgery. Get my assessment by the specialist tomorrow so hopefully I'll be able to report that the conservative (i.e. non-surgical) treatment has worked.

  • I hope so too Debra - good luck with it.

  • Argh! Went expecting assessment. Instead, I've now been booked in for MRI in the middle of March and assessment in April. Grr. It will be six months since I came of the bicycle and tore the tendon, by then. I had to stand on it for weight-bearing X-rays and it was fine. Fed up with the brace (which hurts - and the tendon stopped hurting some time back). At least he's confirmed I can do more cycling to add to the swimming and Pilates, and set the wheels in motion to get some physio started. Now got to start counting down another six weeks...

  • Had MRI, had assessment (pushed the MRI people to write the report so I could make use of an earlier appointment). Been told I have permanent tendon degeneration and to wear orthotics all my life even e.g. walking around at home. We'll see.

    Started physio and I'm doing the exercises I was set, three times a day. Walked one lap (1.5 miles) at parkrun on Saturday - very tempted to start running but I didn't. Intend to wait until I've been doing the exercises for at least a couple of weeks before trying a few minutes on the treadmill, probably (totally flat surface) then start building up very gradually and see how it goes.

    Orthopod said if it goes bad again he'll consider surgery (moving flexor digitorum longus to replace the PTT) but then would give me only a 30% chance of returning to long-distance running...

  • Hi

    Thought I'd pop in with feedback.

    I spent 8 weeks not running just bikes and swimming. Did a ten min jog on treadmill 3 weeks ago and felt niggle in the ankle so I stopped. Then had the similar nag for a few days. A further 3 weeks and walking a few miles seemed fine so I went out for a run. A slow 5k felt fine when running but today felt achey in general but still weakness in the ankle. So I'm no further forward.

    Just thought I'd give the update.

    This is a a nightmare to get rid of.
  • samsunguser: are you doing exercises to strengthen it? I've had five MONTHS of rest and wearing a brace and now I've started rehab exercises.

  • Hi Debra,

    How is the recovery going?  I am very gradually increasing my mileage in my minimalist shoes.  Started with three three mile runs in a week then increased to three by four the next and so on.  Now at three by 11.  Still a bit of soft tissue ache but the bone seems fine.  All things being well I will go for a marathon in the autumn to make up for missing London this year. Over a stone heavier than I was this time last year.



  • Hi SR, congratulations on that progression - sounds like you are being sensible and being rewarded for it. Good luck with working towards that marathon. As for the weight, I'm sure it will drop off again as you do more running.

    I'm not doing any running yet image. However, I have progressed to starting doing single-leg heel raises (I'm starting with five, three times a day and will work up to 15), and gone from the thinnest thereband to the next one up for my other ankle exercises (extension, flexion, inversion eversion). I'm also doing lots of exercises to strengthen the internal muscles of my feet.

    I walked one lap of my parkrun, so 1.5 miles, the other week when we had lots of volunteers (so I wasn't needed for any finish line duties), and walked 800m at 4 degrees incline and 4 mph on the treadmill on Monday - intend to repeat that a couple of times today. It's going to be a slow recovery, I fear - and I have no idea whether the tendon will be sufficiently functional to allow me to run properly. I can only wait, build up very gradually, and find out.

  • SumoSue wrote (see)

    The scan I had prior to surgery showed there was a small tear in the tendon caused by overuse rather than a trauma.  Re: the ankle bone not sure but the scar goes from below the ankle bone, around it and finishes just above the bone. 

    Hope this helps.


    SumoSue and anyone else experiencing this:

    What did you feel when you had a small tear in your tendon? I'm getting an MRI tomorrow. When I run, the very inner part of my ankle feels weak like it's going to give out, painful but not excruciating pain. It starts out as mild pain but gets more crappy feeling halfway through, and stays the same amount of pain the rest of the run. I'm sore after running (just that shin/ankle). And sometimes my foot starts feeling weak too, like under the arch but not as often as the inner part of my ankle. A small section of where a muscle attaches to my tibia has a burning sensation when I do the "runners stretch." It hurts and i'm limping when i stop running but it doesn't stop me from running if that makes sense. Wondering if theres a tear or just bad tendonitis. The MRI will show I guess.


  • Megzie, the symptoms sound familiar, but like you say the scan will show that.  I was fortunate in that the specialist I went to understood that I wanted to get back into sport as quickly as possible but needed a long-term solution.

    I got the results of the scan in the morning and he operated in the afternoon!

    I'm back in full Ironman training with no issues - just slow, but that's nothing to do with the post tib. image

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