Marathon training - posterior tibial tendonitis

Hi,

I've been training for a spring marathon since October but over the last couple of weeks I've had to put training on hold due to pain in my posterior tibial tendon/muscle. The physio has said my ankle is collapsing inwards due to a week posterior tibial muscle and has given me stretches/exercises to do which I have been doing regularly and had seen some benefit (when I was first injured i couldn't do a single leg heel raise on the affected side but yesterday I could with only minimal discomfort). I've also been doing yoga/weight training in the meantime to try and support my running. As the pain had subsided a bit I tried a gentle 5k yesterday and although there was a bit of pain it wasn't too bad however afterwards it was throbbing again and it's now back to being a lot more painful again. In my training I'd got up to 13miles at the end of January but haven't managed to go over this. I need to decide by the 10th March whether to defer my place for the marathon or not. The marathon is at the start of May and it's my first one so I'm not sure now whether I'll have enough time to train (depending on when i'm pain free and can return to training) or whether I should just look for another marathon later in the year to give myself longer to heal. Am particularly concerned that even when i start back at training I'm going to need to take it easy at first so as not to damage the tendon/muscle again.

If anyone has any suggestions on either whether the training is still feasible with the time left and/or on posterior tibial tendonitis/weak posterior tibial muscle please help! I am so gutted that this has happened as up until a couple of weeks ago i hadn't missed a single training session since October. I appreciate that it's difficult to know the answer to the above but just if anyone has any general advice from their marathon training experience i'd love to hear it!

Thank you

Comments

  • If it hurts after 3 miles now you've not got no chance of running a marathon in May without reinjury.
  • Yeah I thought that might be the case was just hoping otherwise as I said I'd do the marathon to raise money for charity in memory of my cousin. Contemplating seeing how I am doing nearer the 10th March and then maybe changing to the half instead as I don't think that'd be so difficult to train for if I can heal quickly. Thank you for your response anyway.
  • MsEMsE ✭✭✭
    edited February 2017
    Sorry to hear about your injury woes, Emma.  Two points:

    The marathon: I would suggest not looking too far ahead and focusing on getting past this blip for now.  That does probably mean shelving all plans for a spring marathon but I will say that you do ideally want to get through a full cycle of training for your first one.  Otherwise, you risk injuring yourself through ill-preparedness.  Let them know you want to defer  your place and you will feel much happier as the time pressure will disappear. (This then gives you the chance to focus on...)

    The injury: I have had posterior tib tendonitis a few times and been able to stop it developing into a chronic (ongoing) injury.  Being able to identify what the root cause is and address that is crucial. It sounds like you are doing exactly that with a great physio so well done.

    It might sound odd, but injuries are a great way of understanding your body's weaknesses.  Marathon training, with the volume required, forces us to push our bodies to find out where those limits lie.  When we end up injured, the best approach is work out what we need to do to avoid it happening in future.  In a sense, injuries are our best teachers.  And nobody will teach you better than your own body.  

    Best of luck with recovering.
  • Thank you MsE. I totally agree, I wanted to get through all the training runs so that I could be as prepared as possible for the day just wish I'd been injured before I agreed to run for charity! (Had always planned to run it for charity but held off announcing it until nearer the time and literally as soon as I did I got injured! Now with the sponsorship that's already been raised I feel a lot of pressure to do a marathon at some point in the near future but not sure when I'll be able to without knowing how quickly my ankle will heal!) I guess I can always hold off planning any future marathon until I'm fully healed and then take it very slowly (again!). 

    Sorry to hear you've had it too. It's been a complete nightmare as it means I'm limping around even when walking so gone from feeling very happy to have gotten myself up to 13 miles to not being able to walk properly! I'm really not sure what the root cause was as i was building up mileage slowly as recommended, taking rest days and doing strength training but i guess it must just be that the tendon wasn't strong enough. How did you manage to stop it developing? Googling it is quite terrifying with all the images of PTTD which is my main worry re coming back to running too soon.

    I think you've got a good outlook on injuries! I agree this has been a lesson and it's made me focus more on strength training to avoid similar issues in future but it's also made me quite scared of running now which is a shame as i had been really enjoying it!

    Thanks again for the reply :)
  • MsEMsE ✭✭✭
    For me, using a supportive insole such as Super Feet was just the bit of extra support I needed to encourage the niggle to disappear (I don't otherwise wear orthotics).  Also, avoiding roads and opting for trails to encourage more full body engagement when running.  But we are all different and you may respond to other changes.  If you are in pain when walking I would see what is happening with your gait to cause that, work from the feet up to your head!  Podiatrists, chiropractors, sports physios and yoga/pilates instructors etc will all have a view.  The trick is to bring all the perspectives together to formulate what you think is happening yourself.  Leave Dr Google for now.  It will only confuse you and you need someone to look at you to give you a relevant PoV.
  • Ask the physio t issue you with an orthotic, there are cheaper off the shelf devices that can help. But you may need a custom one. If so see a Podiatrist.

    Our approach 
     would be focussing hard on calf flexibity and deep tissue work on the leg. Ankle and forefoot joint mobilisation.
    Strengthening an injured posterior tibialus may not be sufficient,  tendon needs to be off loaded to help it recover. The collapsing certainly points towards forces that can strain the tendon.





  • Thanks Footmech. The physio did mention that that might be necessary last time but he wanted to see how I was getting on with the exercises first. I go back next week so I'll make sure to ask then.

    Thank you for your suggestions. I know I've always had inflexible calves so I'm not surprised that's part of it. I'm trying to rest it as much as possible now (in between the strengthening exercises) so I've stopped walking as much as i used to to try and help it heal quicker. In terms of the collapsing I've tried to be more aware of my foot positioning and walk 'upright' if that makes sense and not let my foot collapse down. Do you think that is helpful or am I just making it worse?

    Thanks again.
  • Emma, I had a PTT niggle in 2013. I nursed it through five 50-milers - then came off my bicycle and tore it. Ended up in a PPT ankle brace for several months. Off-the shelf orthotics can give some support, also kinesotaping, and neither of those interfere with running. Taping can be left in place for several days at a time. The Aircast PTT brace gives total support allowing the tendon to rest completely, but (in my experience)  needs extra padding (if you have a sore PTT, having a hard plastic tube going straight across it is a stupid design flaw) and they are not cheap.

    Strengthening the foot intrinsics is worthwhile - mine on my left foot are noticeably well developed now. I did that by barefoot running, mainly, but there are exercises such as towel grabs as well - don't try barefoot running until the tendon settles anyway.

  • Emma hi,
    the physio, has to have enough sense to know when our interventions are necessary. 
    Go with the program 
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