Posterior Tibial Tendonitis is a little known yet fairly common injury among runners. The posterior tibial tendon sits on the back of the ankle region on the inside of the lower leg and connects the calf muscle to the bones on the inside of the foot.
The main function of this tendon is to stabilize the ankle and support the arch of the foot, both of which are necessary functions for anyone attempting to run. Unfortunately, many runners fall victim to injuries in this region.
Posterior Tibial Tendonitis can occur due to a severe, acute injury (such as a bad fall) or due to overuse, both of which lead to the tendon becoming inflamed or even torn. This causes the athlete to feel pain on the inside of the ankle or underneath the foot. Over time, if left untreated, a weakened posterior tibial tendon can leave the arch of the foot unsupported, causing flat-footedness. This exacerbates the problem because flat feet tend to lead to over-pronation where the ankle turns inward while running, thus putting further strain on the posterior tibial tendon.
If you are experiencing pain in your posterior tibial tendon, it is recommended that you contact a medical professional as soon as possible so you can begin therapy to heal the injury. In the meantime, there are several forms of treatment you can begin that relieve pain and start strengthening the tendon.
First, lower your mileage considerably and if the pain persists then stop running entirely. Begin icing the ankle region several times per day to reduce inflammation. Next, you may want to consider purchasing a pair of running shoes with arch support. These shoes have a dense foam underneath the midfoot that helps hold up a weakened arch, thus preventing your ankle from turning inward and stressing the posterior tibial tendon.
Another option to the same end would be to purchase a pair of generic orthotics at your local run-specialty store. If you feel like you would prefer a more supportive and personal solution, getting a pair of custom orthotics from your doctor would be your best bet. These orthotics are made specifically for your arch type, though they tend to be quite rigid which turns some people off of them.
There are also some strength exercises that can help alleviate Posterior Tibial Tendonitis. Most of these exercises strengthen not only the posterior tibial tendon, but also the other muscles of the calf. Remember that when an injury occurs it is not just the injured tendon that is the problem, but often there are weaknesses in many muscles surrounding the injury.
The first two exercises both utilize resistance bands and are called resistance band inversion and eversion exercises. Basically, these exercises are done from a sitting position with your legs out in front of you. Tie the resistance band to a nearby stable object, then loop the other end around one foot. You will then make sure the resistance is coming from the outside of your body and you will bring your toes inward 10 times, then repeat on the other foot. After that, switch the direction of resistance, so it is now coming from the inside. Now you will move your toes to the outside. Do 10 reps on each side. After completing those reps, repeat for 2-3 sets.
Once that is complete, head to a set of stairs or a stool. Now you are going to do eccentric calf raises. Stand on one leg on a stair and inch backward so that only the ball of your foot remains on the step. Slowly bring your heel down as far as it can go comfortably, then rise back up until are on your tippy-toes. Repeat 10 times, remembering to go slow. Next, turn your foot inward and do 10 reps in that position before turning your foot outward and repeating. Finally, switch legs and do the same routine on the second foot. You should feel this in your lower calf and in the ankle region.
Posterior Tibial Tendonitis can be a tough injury to overcome, but if you stick with your recovery plan and work with a knowledgeable physical therapist you'll be running before you know it!