Thursday, May 13, 2010

Posterior Tibial Tendonitis Recovery Story

I received a comment on my blog today asking me to tell my Posterior Tibial Tendonitis recovery story. Other people have found my blog googling the same issue, so I thought I'd post about it since I didn't really say much after I was diagnosed. So, this story is for you, Tammy. If you have any questions that I don't answer here, feel free to ask!

I guess I'll start by explaining when it all started, how I felt, and then what I did to resolve the problem. I had run 3 half marathons in 2009 with virtually no problems, and I decided I would run the LA Marathon in April of 2010. I made a sub-goal to also qualify for the Boston Marathon, so my training time goals and workouts were with this goal in mind. My training was going awesome, actually, and even though I had the Boston goal in mind, I was truly trying to follow my body and didn't feel like I was overexerting myself.

My problems began when I received a new, lighter pair of shoes for Christmas. I had previously been running in Mizuno Waverider 12's but decided to try the Mizuno Elixir 4's because although they were in the same class of shoes on Runner's World, the Elixir's are a lot lighter and have far less support. I never tried them on before buying them and I immediately knew when I received them, that I probably needed more support. I didn't want to wait for new shoes or spend more money, so I used them anyways. This was an idiotic move on my part, but I thought I'd be okay.
I can't blame everything on my new shoes because I was also putting more mileage in, so the culmination of these two factors was probably what lead to injury.

Anyways, I started feeling soreness and mild pain above my ankle, but I just attributed the pain to the toughness of training for a full marathon, so I didn't give it much thought. I stretched a lot and tried to roll out that part of my leg with my Marathon Stick. For awhile, I thought this helped, but the pain still lingered. My mild aching above my ankle turned to debilitating pain within the course of 2 weeks. It didn't really hurt that much when I walked, but when I tried to run, I limped and couldn't even run a mile. I started cross-training with the stepper at the gym, but there came a point where I could barely do this. I probably should have gone to the doctor at the first sign of pain, but I didn't want to be a sissy and was hoping it would get better.

I finally went to see my doctor and the PA on duty took X-Rays. He and the X-ray techs initially thought I had some trauma on my bone and referred me to a podiatrist. When I went to the podiatrist, he pushed my foot around in different directions until I squealed. He was able to diagnosis fairly quickly that I had posterior tibial tendonitis caused by too light of running shoes and over-pronation. I was surprised to hear I overpronated because I had my shoes and run analyzed at my local running store and they thought I was a normal pronator. They were wrong. So, the shoes that hadn't caused me problems in the past, were technically wrong for me.

The podiatrist gave me two options: I could either purchase shoes with more support or get fitted for orthotics. He said about half of his marathoners choose orthotics, and he highly recommended I go that route. I did. It took two weeks for my orthotics to come in, so I went back to using the stepper to cross train, hoping that I could still run my race. I had a lingering chest cold that I came down with a few weeks before Christmas, and I probably should have stopped working out altogether, but I didn't. My chest cold became worse, and I went back to the doctor and found out I had full blown pneumonia. He said running my race was now out of the question, and I just needed to take it easy.

I was really depressed over finally deciding that I had to throw in the towel. But, in the end, taking a rest probably not only helped my lungs recover, but probably helped my tendonitis as well. I was supposed to run the LA Marathon in March, and it's now May. I've been running 15-20 miles for the last month or so, and started training for a new half last week. I feel my orthotics have helped me a ton and I don't feel pain anymore. At first my orthotics felt like a piece of wood in my shoe, but now I barely feel them. I'm not putting the kind of mileage I was before in, so I guess only time will tell. If you're dealing with a posterior tibial tendonitis problem, and I didn't answer a particular question here, feel free to ask. I suppose my recovery story is yet to be concluded. I'm thinking about another full marathon in November, so hopefully my new orthotics will continue to make a difference. Hope that helps!

41 comments:

  1. Thank you so much for taking the time to write up this post. It gives me a lot of hope.

    Like you, I've found the orthotics have made a noticeable difference in my recovery.

    I am hopeful that my orthotics, combined with supportive shoes, will get me to the marathon finish line in October.

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  2. i'm glad you found a solution and were patient through the recovery! hopefully no more time off from injuries ever again :)

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  3. Yeah, those shoe store people did the same thing to Sneaker Sister up in PA, gave her the wrong running shoes and she got injured because of it, that was a few years back but It's enough for me not to trust them.

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  4. The Mizuno Nirvana is an excellent shoe for this condition. Probably will work w/out orthotics due to it's high arch structure.

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  5. thanks for the heads up about the mizuno nirvana, whoever are. I was sure what shoes would be good for me, because having too much support could create problems too.

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  6. I just came across this as I was researching shoes for PTT. I have gone through the same ordeal. I was running in Asics Gel Nimbus and Gel Cumulus...the wrong shoes. I now have custom orthotics and am looking for the best shoe for PTT. I'm going for a gait test this week, and I'll check out the Nirvanas. I have a few races coming up and I'm worried about the pain! Great post!

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  7. thank you for posting this blog. you have given me hope for the furture in my running. =)

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  8. Found this blog when trying to find more people with this problem. I also was diagnosed with posterior tibial tendonitis mid August. I am supposed to run a marathon in mid October. For me, my problem started when running on the beach (uneven surface). I went to the podiatrist who put me in the right shoe (I was also in the wrong shoe). How long did it take you to heal? I have put on training for 3-4 weeks but am still determined to run in October. As of now though, I can only run a mile before I feel discomfort. If you could please let me know how long your tendon took to heal, it would be greatly appreciated. Not running is so hard! At least spin class everyday has been helping!

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  9. Besides the orthotics, did you do those strenghtening and stretching exercises? if so did they help?

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  10. Man, sorry Christina, I didn't realize you commented and now your marathon's probably over. It's difficult to answer your question because I didn't end up running my race and had pneumonia as well, which took me out of running. After about a month of rest, I was good to start training again. Gerry, I don't know about the stretching exercises. Do you have a link? I'd be interested. I just rolled out my legs with my marathon stick and that seemed to help. To be honest, the orthodics have helped a ton!

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  11. If you google posterior tibial tendonitis exercises or search on youtube you'll find them all over the place

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  12. Laura, first off, thanks for your post, I was glad to find more detail on how someone else worked through this problem. Second, I'm curious as to your running style- do you run forefoot (as in land on your mid sole) or are you a heel striker? I'm asking because I have been running forefoot for a few years now, but after really increasing my training (and running the LA marathon in March!) I developed posterior tibial tendonitis. I didn't think that arch support was important if I wasn't rolling off of my heel, but maybe I'm wrong about that. Thanks for your response in advance!

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  13. Did you put the orthotics in the shoes that initiually gavey our problems or did you purchase different shoes as well?

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  14. Josh- I'm a heel striker. I need to learn to run the other way. Anonymous: I bought new shoes but sometimes I wear my orthotics in my old shoes. No problems so far.

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  15. Hello Laura. You have a very inspiring story. I am going through the same problem with the posterior tibial tendon giving me problems. To make a long story short, I just got a second recommendation from a ankle specialist in which is saying that my problem is that I supinate when walking/standing/running. Therefore, she prescribed me custom foot orthotics in order to put my ankle into a neutral position when I walk/run. She then added that since I am supinating, that may be the reason for my posterior tibial tendon getting irritated and inflamed. My question is, how long did you wear your custom orthotics until you started to feel a relief of pain in your posterior tibial tendon?

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  16. I am trying to determine if I need orthotics or just more supportive running shoes. I have mild pronation and went to the ortho last week for posterior tib. tendonitis. I looked at the Mizuno nirvana. Will that be enough or do I need orthotics with that? Thanks so much!

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  17. I too have PTT in both ankles and I am currently in PT weekly and have a set of great strengthing exercises that I am supposed to keep up with daily but I fall off sometimes. I continue to run with the PTT but I take an anti-inflamatory prior to running and I sretch and ice immediately following my run. My Dr. referred me to try "Super Feet" inserts which are about $30 a pair and you can get them at any running store. They really make a difference and I have them in my Mizuno Wave Runner shoes. I don't think they are enough because as I've ramped up my mileage to get ready for a 1/2 marathon I've notice more pain on the right ankle now---so I think that the custom orthotics will be the way to go. I definately recommend seeing your Dr. as soon as this comes on so you can get the anti-inflammatory pills and the prescribed PT. Also I do daily massage of the area around my ankle and up the tendon at night before bed which helps.

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  18. Thanks so much for the blog on this topic! I have a question - i was diagnosed with PTT, but my symptoms sound different from everyone else's. I get sharp shooting pains near my posterior tendon, but its usually while walking. I never had it while running or right after running. Everything I read from others is more of a general ache/pain, not sharp. The sharp pains are debilitating! An MRI came up clean....

    Thanks!
    -jen

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  19. Great blog. Thanks.... Felt pain for first time less than two weeks ago. Podiatrist said I had PTT and said I would be ok for LA marathon but its only a month away and I still feel pain from time to time. Haven't run since, just cycling. I see him again on Tuesday which will be 17 days after. Anyone think its possible to come back within six weeks?

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  20. PTT is the worst... ugh

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  21. I started having inside ankle pain last October while cycling. I pushed through it and the next day I could barely put weight on my foot. Went to the doc and eventually had an MRI which revealed PTT w/ likely tear. I was on crutches for 2 weeks in a boot for 6 weeks. I did some light road & mountain biking for about a month when I finally decided something just wasn't right and have gone back in the boot for another month. I'm also doing aggressive physical therapy to see if that will help it heal fully. It is a very frustrating injury that is hard to heal.

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    1. I had PTT. No MRI yet, because I can do single affected foot toe raise. I also felt it first in Oct.2012. slowed running but spinning like a nut. now stopped everything and waiting for big time ubcl orthtics. i wonder if there is a tear- but strong legs can still toe raise with tears.? (let me know ) i've been told it's like a sprain and PT could be making it worse. My plan is to wait for braceing orthtics and just do ultrasound, topical steroid tx at PT. untill my leg has the stability of the UBCL>

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  22. I was diagnosed this week with PTT. I have been running on gravel/rocky roads and I think I must have tweaked my tendon. I first noticed it about 4 weeks ago and continued to run on it. Took advil twice a day for a week and it seemed to relieve the inflammation. This week a Podiatrist fitted me for orthotics and I am hoping that will help the problem. My question is...should I not run at all until my orthotics are ready (about 4 weeks from now). Is walking ok? Thanks for your help.

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  23. i wish i had stopped. i'm a nurse so not walking isn't an option. but i found of few days off and then i'd run. i set myself back.
    my dr. would say"Would you run on a sprained ankle?" no. tought for a runner to hear.
    My friend was dx with PTT. Took 8wks off and pt and is running better then ever. I wish i didn't keep pushing. March 31 is my post.

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  24. any suggestions from anyone on cross training through this injury PTT? I tried to bike 30 minutes easy today and ankle is worse again :(

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    1. honestly if i could start over i would have done exactly what my friend did- nothing for 8 weeks. i was afraid to lose my fitness base so i biked and swam, walking at work. all causing symptoms....
      i hope my orthotics and PT work.

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  25. I too got PTT then pneumonia straight after! Rested for 2 months then started running again. After 2 weeks my ankle is painful again. Going to see my physio on Thurs - I need help cos I'm doing a half maarathon trail run in June and a full marathon in November

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  26. i'll keep you posted. Today marks 6wks of 0 biking and running.(RN- walk at work) PT for 4wks 2-3 times a week. My ankle pain has moved from the PTT area to front ankle joint area. But today I pick up my UBCL orthotics. I hope this works. If i raise and lower my foot on a stair step the deep flex hurts. also flexing foot turning inwards is stiff and painful.

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  27. Hi,

    How are your orthotics and did your mileage increase? How about pace?

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    1. orthotic is flexible plastic that wraps my foot , cups my heel, and surrounds my medial side. running shoe tighten is the final support. not sure? once i can run pain free the plan is to scale this thing down.still in PT, have to get use to it over a weeks time. in PT i ran for 2min at 5.5 x2. this sucks(pace)but no pain
      i'm a female 3:30 marathoner, (x16) 1:36 half, tri's and ironman wanna be. saw a chiro today for possible hip imbalance and ART? I should really just get an MRI. Friday will be 7wks of nothing. I keep thinking of my friend who bet this with 8wks off and PT. no orthotics. she just ran 3:30 at 44 yrs:) Time will tell and i promise if i bet this, or show improvement i will post

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    2. Anon...I'm interested in hearing more about your possible hip imbalance. I'm trying to get back into running again after my injury, going back to school and another kid. My PTT is gone, but my hip is hurting when I run. Now you're making me wonder if it's related. 3:30 marathoner...that's awesome.! Work it.

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  28. I am really amazed how you manage this blog for 3 years. You have a lot of support. :) I had PT before and I also used orthotics since I play tennis. I didn't want to suffer from PT for the rest of my life, which is why I never stopped from seeking help and advices. My orthopedic surgeon, Dr Grossman, told me to have a stem cell therapy and he explained me how it works. I agreed to undergo treatment, hoping that it will free me from pain. The treatment was successful and I am glad that I was one of the few tendonitis patients who got over it. :)

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  29. Glad to hear your PTT is gone. My hips don't hurt but they checked if my hips were level with my rt. orthotic, i didn't stay neutral. I twisted slightly left. This made me wonder if that's way i had plantar fac. and now PTT in right foot. thinking maybe i threw my leg weird while running . when i came back to running last summer i did have hip pain. I was told by ortho dr. if it's deep in groin it's joint, but if outside(like mine was) i need streching. so i asked a yoga teacher about hip opening ideas. i sat on floor, legs out and bent forward, then legs some what indian style bending forward and hold then switch legs. i hope this helps

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  30. To female 3:30 marathoner, April 30

    It's been a few months--any news? You promised to post:)


    To Michael Garrett
    How much Stem Cell therapy did you do? How many injections? Don't they withdraw your stem cells and mix them with HgH or something, then inject them back in?

    Thanks

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  31. I developed PTT while training for a marathon in October 2011. I cross-trained for a month before the race (didn't run at *all*) but completed the marathon, hurting rather badly at the end. Took about 2 months off and when I was still hurting I saw a podiatrist. Got custom orthotics, went to PT, but still hurt 6 months later. Tried prolotherapy treatment, continued my rehab exercises, and got a second pair of orthotics to wear in my everyday shoes. About 12 months after my marathon (Oct 2012) I started a very gradual intro-to running program (like 30 sec run, 3.5 min walk, changing the increment by 30 seconds every 2 weeks!). Now I'm up to 3/1 run/walk and around 3.5-4 miles 2x/week. It's mostly fine, but I still have to be pretty careful. Last week I only left one day between runs and now it's been hurting for 3 days. I've also tweaked my gait biomechanics, shifting to a fore-foot strike rather than heelstrike, and adding some strengthening. For everyday shoes, I've started interspersing increasing amounts of minimalist shoes to work on strengthening the intrinsic muscles of my feet. I probably wear minimalist shoes around 50% of the time now, and supportive shoes w/ orthotics the other half of the time (or any day that my ankle feels tweaky). This is incredibly frustrating. It's been nearly 2 years now! Anyone have any other ideas?

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    1. female 3:30 marathoner-MRI on 6/24/13 8 months after injury/pain states"mild distal posterior tibialis tendinosis and probable mild tenosynovitis but without superimposed tear. there is also abnormal soft tissue swelling and edema along the medial margin of hindfoot and just anterior to the tendon. no underlying acute fracture or malalignment. and it showed prior plantar fascitis." My dr. said Stage 1 posterior tibial dysfunction. His advice was to proceed with caution. I am now running in Brooks addiction with powerstep and sometimes my UBCL orthosis. I'm running 3 miles slower then normal every other day. then sticking my foot in a bucket of water and ice. so far so good but it still hurts a bit. The Dr said if it continues to bother me he can debride the tendon and clean out the joint.? on a side note I'm off work and running for one month july22-aug22(unrelated surgery) then i will really see what my situation is. I have several questions that can't be answered like will this progress through the stages if i continue to run? will it go away completely? will running in motion control shoes cause new problems? so i will post again once i begin running at the end of august. i really want to be an ironman.......

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  32. I came across this blog while looking for better running shoes. I too have PTT, diagnosed in Feb 2013, was put in a cast for 4 weeks and given PT to do and fitted for orthotics. Did not run on it for 5 more weeks after the cast came off (which was extremely hard to do). Slowly started increasing my mileage in June, and now the PTT is back. I have been off from running a month now, and it feels a little better, but I can still feel it when I walk. I don't want to go back in a cast...so I am going to wait another month to get back out and run. I don't want to do surgery, or end up with flat feet.

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  33. I am experiencing the same PTT as everyone else. So far the things that have helped me are (in order of effectiveness) ART (active release therapy) done by a licensed chiropractor, Superfeet green insoles, Features compression half sock for plantar fasciitis ... Also cutting long run days short... easiest way to do this is to run 2 mile loops near your house. When pain starts to set in just stop and walk home. Immediately ice and then heat 24 hours later until you run again. Cycling doesnt bother my PTT at all so I cross train a ton on the bike. In fact the bike is what ultimately lead to this condition as my cardio/endurance became better than my tendon/leg strength could support. I went from 10 miles a week running to 30+ in training for my first Marathon (spur of the moment decision.) Had pain on my first long run of 12 miles. Kept going on long runs thinking that pain was just normal. Now Im about a month and a half into PTT pain. Some days I can do 7 miles pain free ... others I do 2 miles and it hurts like hell. After my race in 3 weeks I am taking time off from running and exclusively cycling on my trainer. Good luck to everyone and I hope you all recover quickly.

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  34. Found this searching out information on my out PT pain...I think I don't have actual tendonitis, or possibly the very start of it..I can't/couldn't run, due to the burning pain that would happen in my right foot.
    I severely overpronate. totally flat feet. That alone can cause a host of issues, hip pain being one of them...the entire right side of my body (hip down ) would hurt off and on while I was doing the c25k program..
    I had had this weird high ankle pain for a while, didn't think much of it. I noticed it when going down stairs for the longest time.
    A combination of killing my running shoes (asics Kahanas...trail runners, great shoes for overpronation, inexpensive in comparison) and reaching my goal of 3 miles, FINALLY!
    Ive taken a month off, just got some inserts for my shoes...and some KT tape..
    im going to stretch EVERYTHING i can, ice before I go, and start on a lower level of my program...
    Running has really changed my life in many ways. Not being able to is KILLING me.
    thanks for your information...

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  35. I have had mild PTT for the past year, and after running a half marathon through the pain, it got really bad. I have been trying everything to cure it, and after two months of not running, I think I am finally on the mend. What has helped me is completely cleaning up my diet, wearing a Strassburg Sock at night, getting new shoes, new arch supports, sticking my leg up to my calf into a bucket of ice water as often as possible, acupuncture, massage therapy, cross training (I pool ran, because my doctor told me not to do anything else or else it might irritate it), and KT tape. I tried to wear my running shoes with my arch supports as much as possible because wearing shoes without arch supports really irritated it.

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