Posterior Tibial Tendonitis, Left Foot, 2nd Month, Need Help

by Carlos O.

Good morning. I purchased a quick response from you.

I have been diagnosed by two specialists with posterior tibia tendonitis, left ankle. The current foot and ankle specialist has me in a walking boot up to the knee for another 3-5 weeks. Progress is very slow and seems stagnant at times. I would like to give you the history so you get the full background.

1. I am 38 years old. 6 foot 1. At the time of the first signs of a problem I weighed about 240 lbs. I would exercise regularly and had a large build with a good amount of muscle. My main exercise was the treadmill, at 3.3mph, 3% grade, for 30 minutes. 3x a week. I had been doing this for at least 7 years.

2. Around late April of this year, while wearing sneakers that were a bit small for me, I felt a sharp pain in my left ankle. I shrugged it off and kept exercising.

3. I felt nothing for the next 3 days. I lived may life as normal.

4. By day 3 of the pain in the left ankle, I noticed a lot of swelling all over my left foot. I felt no pain. I had no idea what was going on.

5. I went to see my general doctor and she told me it was a sprain and to be patient. The swelling focused on the inside ankle.

6. I wear dress shoes to work for periods of at least 12 hrs a day.

7. I went to see specialist number 1. This is about 10 days into the affair. He observed me quickly and took x rays. No MRI. He diagnosed me with posterior tibia tendonitis. Told me to wear the air cast and go to physical therapy.

8. I went to physical therapy. The PT told me the air cast was not useful. I didn't wear it. The PT started me on some rigorous ankle exercises that were not good for me. The swelling got worse. When she noticed after about 3 or 4 sessions, she stopped the physical activity and focused on massage, ice, heat. etc. she also suggested I see another specialist.

9. I saw another specialist whose care I am now under. He was concerned with the degree of swelling I have. He ordered an MRI. He ordered me to wear a walking boot. He told me I would need it 4-6 weeks and that I should be fine depending on the MRI. That was 2 weeks ago.

10. Last week: I one upped the doctor and put myself on crutches. I did not use the boot. I laid down as much as possible, elevated and iced. I made a lot of progress. I took the MRI and the 2nd specialist told me there were no tears and to keep using the boot. I had made progress but there was still swelling, on both sides of the ankle. No pain as I walk, however. I saw the doctor at the end of the week and he said I had made a lot of progress and said I had weeks to go in the boot. He discouraged the crutches.

11. This week: I used the boot all week. I would take it off when I could at work, would elevate my foot, and would ice with an ice pack. I would also take warm Epsom salt soaks. Of course, I stopped exercising altogether last week and this week.

12. I found your website. I did the ice dip this morning. And now I am writing you.

Of course I have several questions but I do not want to limit your thought process and how you think this through for me. Generally, I have 3 questions.

The first question is generally what you think I should do.

Secondly, how do I protect my other foot, the right foot, since it feels a bit sore, but is not swollen, after a week on crutches and now a week of the boot.

Thirdly, how likely it is that I can get over all this and return to regular exercise, and what that exercise should be.

Let me also note that I am taking this opportunity to lose weight and try to eat better. This has been challenging emotionally for me since I now realizing how fast pace of a life I lead and how I was not taking care of my body.


Joshua Answers:

Hi Carlos.

1. Your main exerciser was the treadmill and you lifted weights, or you just did the treadmill? I'm not sure if you're saying you're big with muscle or big not with muscle.

2. You were just walking on the treadmmill and felt some pain suddenly?

3. Ok.

4. Describe 'a lot of swelling'.

5. Why exactly did she think you had a strain (the stretching or tearing of a muscle or tendon), as opposed to anything else

6. Ok.

7. Why did he diagnose you with that, as opposed to anything else? What exactly did he expect an air cast to do?

8. So your PT had you do vigorous exercise to fix something that was theoretically caused by mild exercise? And that didn't go well? Interesting.

9. What did the MRI show? What did he expect the walking cast to accomplish?

10. What kind of progress had you made?

11. See: Rest

See: Pain Causing Dynamic

See: Process of Inflammation

See: Wrist splints and braces (and mentally replace 'wrist' with 'ankle', etc.

12. "The first question is generally what you think I should do. "

I think you should get the Reversing Achilles Tendonitis program. It will tell you what to do.

The Posterior Tibialis is in there under the bigger muscles of the back of the lower leg, and you need to work it all anyway (as the program will describe in detail).

That's kind of a brief response, but as a general rule I advise a complete plan of attack, a tip or a trick isn't really going to get you the results you want.

"Secondly, how do I protect my other foot, the right foot?

Effectively treat the problem foot, and do some self care on the other foot, as at least some of the factors affecting the 'bad' foot are affecting the 'good' foot too.

Think overall function and all the working parts, as opposed to 'there's one little spot that is the entire problem'.

In other words, you don't really need to 'protect' it. It's likely that reversing the current negative causative factors will allow your body to correct itself (on the other leg).

Having said that, it never hurts to give both sides some love.


Please reply using the comment link below. Do not submit a new submission to answer/reply, it's too hard for me to find where it's supposed to go.

And, comments have a 3,000 character limit so you may have to comment twice.

Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

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Comments for Posterior Tibial Tendonitis, Left Foot, 2nd Month, Need Help

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Jun 06, 2015
Answer to third question
by: Carlos O.


"Thirdly, how likely it is that I can get over all this and return to regular exercise"

At this point, I don't see any reason why you couldn't get over it entirely. You just need to get your system and structures working more optimally again.

"and what that exercise should be. "

I don't talk about or deal with exercise. Exercise (generally) isn't going to fix anything. You need to reverse the factors that are keeping your body from working well, and then your body will again work well/better.

The Tendonitis dynamic is a predictible, progressive mechanism made up of several factors, all working together to conspire to cause pain/problem sooner or later, quickly or slowly.

It can look like a lot of different things, depending on exactly what those factors end up affecting...whether it's actual sudden injury because structures can't handle the load, or slow onset of pain, or pain and swelling, etc.

See: What Is Tendonitis?

"Let me also note that I am taking this opportunity to lose weight and try to eat better."

Rock on!

"This has been challenging emotionally for me since I now realizing how fast pace of a life I lead and how I was not taking care of my body."

Well, you're 38 now...that makes total sense. :) Youth only allows that liberty for so long..... I was about 33 when I first started having thoughts like 'hey...I'm noticing an unpleasant trend here.....'

More questions, more answers.

Jun 06, 2015
response to yours
by: Carlos

Following the numbering:

1. To clarify, the main exercise was the treadmill and setups and pushups. That's it. I'm big with muscle.

2. I was just on the treadmill and felt a sudden pain. I kept walking.

3. Ok

4. Inside of the ankle swollen. Swelling was not severe but was bad. Then the top of the foot. It got worse each day. shoe felt tight. After PT, then the outside of the ankle started to swell.

5. This was my main Dr with no specialty. She just glanced at it and figured it was a sprain. I then saw 2 specialists.

6. Ok

7. He looked at x rays and observed me standing. Told me the air cast and PT should correct the problem. Untreated it would result in flat foot and need surgery, he said.

8. The exercises felt vigorous for the moment: bicycle, squats, standing on one leg and throwing a ball at the wall. After all this the outside of my foot started to swell.

9. mri said no tears, 2nd specialist said. He said walking boot plus PT (after a period of 4-6 weeks on boot) should clear it up.

10. Once I decided to stop putting weight on the left ankle and switch to crutches (and this was before I just started to walk around on the boot), I noticed: swelling around calf gone, swelling on top part of foot gone, bruising/darkness on inside of ankle diminished, swelling went down all around.

11. I did ice dips twice today. And the massage. It seems to be working. I am going to keep using the boot only because I do not at this point until I see the 2nd specialist again next week.

12. Got the book and read it. Wondering if it applies equally to posterior tibial tendonitis. My nutrition is not the best. Will get magnesium immediately. I think I take the other vitamins.

I am not a fan of the boot, and no one could possibly be. I am hoping that it is not causing any harm and that it is not impacting negatively the other foot not wearing the boot.


Joshua Comments:

Hi Carlos.

4. Hmmm. That's not particularly 'normal'. Common with actual rip/tear injury. Presuming the MRI was accurate and nothing was visualized then there's no (significant, at least) rip/tear.

But even a small one can trigger a big inflammation response, and one aspect of that is the body traps fluid in the area, and thus, swelling.

Not worried about it at this point.

5. Just glanced at it. Yeah......that's about how it goes most all the time.

10. Oh..bruising and darkness. Certainly something little did tear, if only a blood vessel. Again, not necessarily anything to worry about other than to reverse the factors causing the symptoms.

11. this point you do not...what? I think there's some words missing there.

12. Yes, it is just as effective for the post tib. It's all connected, and tendonitis is tendonitis regardless of 'where' it's at. So really in the program you're learning concepts, and you can apply those concepts anywhere. And realistically, you're dealing with the entire lower leg, all the structures and geography, not just the post tib itself.

Jun 07, 2015
Last night
by: Carlos O.

Joshua, good morning. Re read the Achilles program again today. Did some ice dips and then the massage. Am elevating the feet. Am tempted to not wear the boot after last night, which went like this:

Wore the boot. Sat at a table unable to really stretch for like 4.5 hrs. Of course no icing or massaging during that time. I was at a restaurant at a party. By the time I got home, booted foot was more swollen than during the day.

Sadly, my good foot was a little swollen too. By morning swelling was gone from good foot and bad foot looked like it did 24 hrs earlier. I am left wondering if (1) I'd do better without a boot at all (2) if I should wear the boot and it's only natural that after 4.5 hrs I'll be swollen.

Next question as to ice dipping and massage:


Joshua Comments:

The timing is a beginning recipe. SO yes, that 40 min thing is about right. But what really matters is that you do as much little bits of the self care as possible.

Especially with the swelling. You need to go crazy ice dipping to try to get the inflammation process to quiet down. It's either stuck on, or there's something hurt in there that is telling it to continue to swell that much.

Either way, ice dip like crazy. You don't have to wait four minutes, you just need to wait long enough for the tissue/area to warm up again. SO you can wait a minute, or you can wait 10 minutes or 30 minutes, depending on your schedule and your motivation.

I'm not clear on the process. Is it: dunk a foot for 10 seconds, wait 4 minutes, repeat this process 10x? That's about 40 minutes when it's all said and done. If I'm correct is that 40 minute routine something to do once, twice or 3x a day?

Right now, the more the merrier. Inflammation is pushing in one direction, you're going to push in the other direction with ice dips.

Whoever pushes most, wins.

Personally, I think the whole 'boot' theory is flawed. If you just had surgery to reconnect tendons or something, that's one thing.

But your doctor prescribed the boot hoping that the immobilization would help...but that's a seriously flawed premise.

If there's no rip and tear...what's immobilization going to help with, really? And immobilization comes with its own problems.

You're swelling (more?) while in the boot, so A. it obviously doesn't prevent swelling and B. immobilization prevents movement which is the prime mover of fluid out of the foot (Movement, or gravity/elevating the foot).

I'd worry more about pushing back with the ice dips and doing the specific massage on the lower leg.

That's a little weird your other foot is swollen. Is that a new thing for you? Or do you have circulatory/other health issues that might lend towards swelling/not enough systemic fluid movement.

Apr 19, 2016
help me
by: Anonymous

I'm 50 years old woman. Weigh around 144 pounds, 5 foot 7 inches. Loved loved loved to walk.

Had bunions for about 27 years got them operated on last November. Prior to the operation (which was why I got the surgery, noticed ankle pain on the right foot (worse bunion there).

On the other side, felt a burning between second and third toes. I was correctly diagnosed (MRI proven) as having neuroma on left foot, and the tendonitis on the other foot.

Had the Lapidus surgery for the bunion was told things should get better for the tendonitis.

Surgery went great, bunion pain gone but the tendonitis worse than ever. Since then nothing has helped. Brace hurts my knees.

Orthotics help a little not a lot. PT did help some but as you said, the exercises made it worse again had to stop. I'm totally depressed. I'm otherwise healthy take calcium, take multivitamin, take turmeric. Nothing has helped me and I'm like an invalid. Just regular walking causes pain and that's all I want to do. Will I walk again?

I don't know if Carlos got better.


Joshua Comments:

Hi Anonymous.

I don't see that you had surgery to remove the neuroma, so presuming it's still there.

If a neruoma pad doesn't help, then the best I can offer is the same self care that should/will help the tendonitis dynamic.

When muscle/connective tissue is too tight it creates pain and problem. Due to the compensations that have been building up over the years due to the bunions (and, ironically, causing bunions), structures in there are definitely tighter than they should be doing jobs they shouldn't.

And when structures are too tight, they don't absorb force like they're supposed to and all that force has to go somewhere.....

Chronic inflammation is a player, dumping pain enhancing chemical into the system, making things hurt more which causes the brain to tighten structures up even more.

Lack of nutrition is a player. For instance, we get enough calcium from our diets but don't utilize it because we don't have enough Vit D and Magnesium which are required for the body to utilize calcium.

I suggest you get the Reversing Achilles Tendonitis program. It deals with the above three factors, and is the work that must be done to start moving things back towards where it ideally should be.

You don't have Achilles Tendonitis per se, but it's ultimately all the same -dynamic-, and the self care is the same, and you need to address all the structures in the lower leg just like someone with achilles tendonitis does.

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