Posterior tibial tendonitis PTTD - Tip Toe magic

Has anyone else had this?

I have been suffering with PTT since last year, 3 months now. Have tried stretching, exercises etc and it sometimest helps. Resting reduces the pain but not too much.

By chance I discovered that 1 of the exercises would dramatically improve things. As in "it's gone away". Depending how many of these exercises I did the pain would go away a bit or completely.

The secret - stand on tip toe. Either slow heel lifts or just standing there. The pain is just gone. Sadly if I miss doing this on any day the pain just comes back,

Does anyone have any idea why this works. I mean the pain was absolutely and completely gone, not just improved or 'a bit better' but gone as in 'cured'.

Martin

Hi Martin, I have PTT, and have had (having sat down and thought about it) for 6 months. I thought it was just shin splints but after completing the Frankfurt marathon back in October, it has got alot worse, one physio also thought I had a stress fracture.

Do you get any discomfort when at rest? this seems to be the worse time for pain and aches...

Are you still training?

I am going to try that technique and see what happens, hope it helps..thanks for the advice.

Hi Steve, Beth,

I am currently still training but not running. I am using a rowing machine and cross trainer and I also kayak 2-3 times a week, 4-6 miles each time.

My exercise routine is to do at least 50 heel raises (combined with arm raises), slowly but without pausing or bouncing, before doing anything. And on days I don't exercise, I still need to do the 50 heel raises to avoid the pain.

IF i miss out the heel raises the pain gradually does get worse, at rest or during exercise.

I'm going to try and include a pause during the lift, see if that helps.

TBH, am a little scared to run incase it just gets worse again.

Martin

Hi all,

In theory, standing on tip-toes will use your bigger calf muscles (soleus and Gastrocnemius) to take your body weight off the Posterior Tibialis(PT).  When standing normally your medial arch should lower (to cushion your weight) and the PT is designed to control that lowering.  If it is overworked (too many miles) or under worked (weak) it could manifest as pain at its attachment sites (inside of shin or foot arch). 

In the chronic conditions (more than one week) it is most likely a combinationn of both the above and should be classed as a tendinosis not a tendinitis, anyway thats just semantics

and what you should be doing is progressively strengthening the muscle by doing stuff like walking on tiptoes (with heels turned in is best) and calf raises and calf stretches.  Progressive means gradually increasing the amount of calf rasies or distances you run/jog.

If it keeps coming back even with exercises, you may have an issue with the joints in your foot being stiff and inflexible (very common with tight shoes e.g. high heeled shoes or footbal boots) OR/and the muscles on the outside of your calf (peronals) being tight and over dominent (also very common) making the poor PT work far harder than it should have to.   A good sports physio should be able to assess and treat these..

My left PTT started hurting in late November after an off-road run in road shoes with inadequate grip. I had a week of no running (while I thought it was a stress fracture to my inner ankle bone) and a month of reduced mileage (25-30 miles/week) before increasing again because I had a 50-miler (Thames Trot) on 2nd Feb. Due to flooding that turned into about 43 miles of mostly-road with some ankle-deep slippery mud (and freezing cold water) on the trail sections.The PPT problem led to sloppy gait and my heels got bruised.

Anyway, I've rested for the last week or so and I've now started exercises for strengthening and mobilising the tendon (the muscle is now fine). I'm finding the following two sets of exercises useful and I'm trying to do almost everything suggested (not the wobble board stuff 'cos I don't have one). After just a couple of days, I can already feel a difference. I'm doing several different exercises four times a day.

1. http://www.bidmc.org/CentersandDepartments/Departments/OrthopaedicSurgery/ServicesandPrograms/SportsMedicine/ForPatients/~/media/Files/CentersandDepartments/Orthopaedic/Sports%20Medicine/Rehab%20Protocols/Posterior%20Tibialis%20Exercises%20092809.ashx
2. http://www.summitmedicalgroup.com/library/adult_health/sma_posterior_tibial_tendonitis_exercises/

(Or Google for posterior tibial tendon exercises" - you're looking for a .pdf from Beth Israel Deaconess Medical Centre, and a page from Summit Medical Group).

I have my next 50-miler in nine weeks so I have to get this sorted asap.

I think this is what a friend of mine had and she went to see Norbert Cauvas at Foot Factor (near Oxford Circus). He made orthotic insoles for her while she waited and it's really helped her. He offers a free consultation for people wanting to find out more so you could book in and see what he suggests doing.

I've had orthotics from him myself and it's made a huge difference to my running - I feel much more stable and aligned and the couple of niggly pains I had have just gone Very happy!

No orthotics for me - I run minimalist and they really don't mix!

hey, they're not for everyone I suppose but I know I couldn't do without now.

I've used them as a temporary measure, to give tendons a chance to rest and heal (like I'd wear a cast if necessary while a bone set), but for the longer term I'd prefer to sort out the problem (heal and strengthen the tendon) rather than rely on an artificial crutch.

However, if they work for you and you're happy with them, that's fine.

I had a tibial stress fracture 2 years ago, I had considered PTTS as a possible cause (Doctors told me I was fine, I was in too much pain to believe them a year after they told me this so I started to do my own research), turns out it was a different issue altogether but it was the same area as PTT.

I took up barefoot running where the area you land on is your forefoot or midfoot rather then your heel and found the issue didn't return: every other time I'd laid off running waiting for the pain to die down it had come back within days so the barefoot style running thing just seemed like the only way I could run.

Guess it works for many things!