Posterior Tibial Tendonitis

When I first went to the doctor at the sports clinic, 12 days ago, I suspected tendonitis. No, no, it wasn’t tendonitis, she said with professional certainty; I had sprained my ankle (without noticing), pulling my deltoid ligament. Humph. Weird that I could turn my ankle and not notice, I thought, but she was a doctor, I’m not. So as advised, I stopped running, left my race bibs in a drawer, went to physio several times, initially for ultrasound and then progressed to ankle strengthening exercises. Rehab was going well.

Still perturbed over the whole ankle sprain diagnosis, I continued my self-diagnosis by Google, and came up with Posterior Tibial Tendinitis (PTT), a common complaint among runners and a condition which left untreated results in flat feet. The symptoms fit, the cause fit; it made sense. The physio conceded that it might be PTT, rather than a pulled ligament, then directed me to the balance board where I remembered why I’m such a lousy skier. She seemed to think it was ok for me to try running again if it didn’t hurt. I can’t blame her for buckling in the face of my determination. And my ankle no longer hurt!
I started running again, a week after the ankle sprain diagnosis. I ran on three consecutive days, ankle taped for support, making sure to ice the foot after each run. Two runs went really well. I was even able to do a decent tempo run. I was back! The third run unfortunately involved some hills due to a road closure. Don’t ask! The foot ached a bit during the 8km loop but pain certainly didn’t prohibit my enjoyment. I started to envisage the start line of the Standard Chartered KL Half Marathon again and dared to hope I might get to cross the finish line too. Yes, I thought, I will be able to run! Whoohoo!
But after the slow hilly run, the foot was sore and became swollen. It was time to get help from a professional who was experienced in treating runners (as clearly, the folks at the sports clinic weren’t). I needed someone who understood not only running injuries but also a runner’s impatience to tie up their laces and get out on the road again as soon as possible.
Now, in my previous life I worked with surgeons in the UK developing orthopaedic devices, and in such milieux, the chiropractor was not highly regarded. As a result, I have held a deep prejudice against such practitioners for two decades. But by last Friday, I would have allowed the man who comes to read the electricity metre to examine my foot if he’d shown any interest, or vague knowledge about ankle anatomy. A chiropractor, in a Joint Specialist clinic, who had been highly recommended by some running folk, did seem somewhat more qualified for the job then the meter man. So off I went again, sitting in traffic for 20 mins, thinking how I could have run to the clinic in 10. But of course, if I could run, I wouldn’t be going to the clinic. Sigh.
After much prodding and poking (what I would call a thorough examination), an x-ray, the subsequent appearance of bruising in my inner foot which I was assured was not related to prodding and poking, a close look at the wear pattern on my running shoes, and another round of somewhat painful palpating of my medial ankle, the chiropractor concluded that it was my posterior tibial tendon and not my deltoid ligament that was injured. Sometimes, it doesn’t feel good to be right.
So two weeks after the initial (mis) diagnosis, I’m back to where I started. Actually, as I’ve made the foot worse, I’m even further back than that. Rest, ice, for a few days, then I will start ultrasound therapy again. As to the cause of PTT after 20 months running? It might be my shoes – I’ve become an over-pronator as I’ve moved from heel to foot strike running, and my shoes are not designed for such – or it might be related to tightened Achilles Tendons, the souvenirs of my blissful barefoot runs on a beach in Vietnam back in April. It’s probably a combination of these factors together with my recent increase in training pace.

Either way, I’m still benched, and I’m back to finding alternative ways of keeping up my fitness and strength without pounding pavements. When the SCKL marathon was postponed in June because of the Haze, I never dreamt that I’d miss the race altogether but I now I certainly will. Thankfully, I think I’ve now found a clinic that will help me back to full fitness. Whether it will be in time to run the BSN Putrajaya Half Marathon on Oct 19th remains to be seen.

p.s. I decided not to treat you to a photo with this post. Frankly, I’m sick of looking at my own feet, and think you must be too. If there’s one minor consolation – and I do mean minor – over not running, it’s the prospect of a decent pedicure and prettier toes.   Hopefully, this improved version of my footsies will be strictly temporary.

6 thoughts on “Posterior Tibial Tendonitis

  1. Hi,

    I’m sorry to comment on an older post, but I’ve recently been struck with PTT and I am desperate for some advice. How long did it take before you could run again? I’ve had symptoms of varying degrees for about two months now, and I’m currently completely resting (much to my dismay). Did you wait until you had absolutely no pain or until your symptoms improved before you began running again? I have a half in August and I would love to get some base training in before I have to start increasing mileage for the race, but I’m afraid to start running too soon and make it worse.

    Thank you!


    1. Mandy, sorry to hear about your PTT. I understand your frustration. I will write a separate post about my PTT this week in the hope that it might help you and others. I need to check my training logs to be sure but I didn’t run for about 3-4 weeks when I first got injured and treated. I waited until I was pain-free. Now I still run when it flares up but twice-weekly physio really helps. Hills really exasperate the condition. Hope this helps until I write something more comprehensive.


  2. If you’re still reading comments on this post…do you think there’s any connection between shoes and this condition? I just started noticing what I think is PTT–aching up my leg from the inside of the ankle during and after runs—as I’ve increased my weekly mileage. I’m not a hardcore runner at all, only 3-4 times of run/walk a week, no more than 3 miles at a time, but I was hoping to increase for a 10 miler soonish. I’m a neutral runner and my shoes are oldish but without much wear since I wasn’t running much till this summer.


    1. Alexis,
      Sorry to hear that you’re having trouble. I’m not an expert but I wonder if you have tried rolling your calves after your runs with a foam roller? I found that even after I had recovered from PTT, I sometimes got niggles in my foot, medial side, but stretching my calves with a roller made all the difference. If your calves are tight, it can impact other connected structures. I changed my shoes to a stability shoe with more arch support than in neutral shoes as I was over-pronating. I have used these for almost a year now and am very happy with them. I chose Brooks Adrenaline GTS but there are several other models also designed for over-probationers. Lastly, try strengthen your ankles and hips to improve stability and balance anatomically. You could google for suitable exercises. Hope this helps:)


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