Potential Posterior Tibial Tendonitis - who to see for a quick diagnosis

Hi All

Short version: what type of medical professional do I need to see to get a quick and accurate diagnosis for potential Posterior Tibial Tendonitis? Assuming "quick" rules out the NHS, how much can I expect to pay?

Long Version:

I started running this summer, in my mid-30's having never really done any running before. I did couch to 5k and have since been increasing my weekly mileage by 10% per week and am currently at about 25 slow kilometres per week.

I did the whole of C25K and my first few weeks post C25K in a pair of old trainers that were ostensibly running shoes, but were cheap to begin with (£20 from sports direct iirc) and had long since given up their support. In October I rectified that by having a fitting and a gait analysis done at a reputable store where I bought a new pair of proper running shoes that fit like a glove.

About 20 minutes into a run on average, I start to feel pain from the inside of my right ankle. It's almost always a dull pain, though I have had a couple of sharp pains there as well (literally two very brief sharp pains in a few dozen hours of running). It's never painful enough to stop me running, but it can be quite uncomfortable both during and after the run. Most of the time the pain is definitely in my ankle, but it does seem to move and sometimes it's more towards the bottom of my foot.

My initial suspicion was that it was down to the old trainers I was wearing and that maybe I had a pronation issue. But the gait analysis showed neutral gait. I mentioned to the chap doing the analysis about the pain in my right ankle, but he couldn't see anything wrong with my gait, and agreed with my suspicion that it probably was down to the old trainers and that my new trainers might resolve the issue. They haven't.

Having attempted a self-diagnosis based on information available online I've narrowed it down to either Plantar Fasciitus or Posterior Tibial Tendonitis. The latter seems more likely as the pain is located in my ankle rather than heel, and I can feel the pain when I try to do a single leg heel raise, which is apparently a dead giveaway for PTT. The case for PF is that the pain can sometimes feel like it's on the bottom of my foot, and there does appear to be some swelling on the inside of the arch of my foot.

I think I have some general issues with my legs. Particularly, I have poor ankle flexibility and tight calves & hamstrings. So there might be something else going on entirely, I really don't know. But having read some articles online about PTT, I'm quite alarmed by how serious it can become, so feel that I should get a proper diagnosis ASAP and take action accordingly.

Which brings me to my question. Which medical professional is best to see in this situation? Should I be looking for a podiatrist, a physio, seeing my GP? Or someone else? I'm assuming to get it done quickly I'll have to go private, any idea of cost?

Thanks in advance. Please feel free to share any other thoughts, does it sound like PTT to you, personal experiences with PTT diagnosis, treatment etc.



  • Position is correct for PTT. I suggest seeing a physio initially. Seeing a medical specialist privately will cost a lot more (couple of hundred vs e.g. 40 quid) and they will probably want to send you for a diagnostic ultrasound or even MRI - both of which cost extra. And yes, PTT can get serious - I ended up tearing mine in a cycling accident (ironically the day I started an intended month of rest to let it settle) and had a LONG time off running. Physio can tell if there are areas of tightness etc. and suggest appropriate exercises. If it really needs rest you can get an Aircast PTT boot - has a little air cushion under the arch of the foot so the PFF doesn't have to do any work. But it's not cheap (and you need to make sure you get the correct one for your leg - they come in left and right as well as different sizes).

    Mae sure you see a physio who is used to seeing runners - preferably one who IS a runner.
  • Hi Jeep,

    I totally agree with Debra, in the ideal world you want to see an experienced professional, who is competent at using MSK ultrasound.
    But regardless of any diagnosis, if running is causing you inside (medial) ankle pain when you are running, then it probably indicates an overuse/repetitive strain injury or muscle/tendon and/or bone, so let it heal up, and work on your running technique, as your probably using your right ankle differently
  • I hope you got your diagnosis already, but just a quick plug for the NHS. I was able to get a quick diagnosis for PTT. There is a musculoskeletal specialist at our local GP practice and he did a few tests and diagnosed me. I rang in the morning and got an appointment that afternoon, so it definitely was quick.
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