Posterior Tibialis Tendonitis, can I run if it hurts?

by Joe Z
(Pennsylvania)

Hi.


I have been getting in shape for a half marathon, and I believe I have a posterior tibialis tendonitis.

The pain I get when I run is in the lower rear part of my calf (between the meaty part of my calf muscle down to and including the ankle, more or less).

Also, there is a very tender spot right behind my inner ankle bone. I didn't see a specific treatment for this, but I am assuming that massage and ice baths, and ice massages would work well for it. (I am not really sure what exactly caused this, although I was using an insole for morton's foot for a while, and I had to remove it since the insole was causing painful pressure, and soon after removing it the tendonitis started up, so I think removing this insole suddenly may have contributed).

Do you have any other suggestions specific to this tendon?

How long should it take to heal if I take the appropriate steps?

And, I noticed that you say that rest alone will not heal tendonitis, but should rest be part of the therapy at all?

Can I run on it if it is a little painful, or should I wait until it is completely pain-free?

Thank you.



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Joshua Answers:

Hi Joe. Posterior Tibialis Tendonitis, you say?

As far as Tendonitis goes, do you think you have actual damage, or just irritation and the body's respoonse to perceived and/or potential injury.

Meaning, things get tight, they start to hurt, and -somewhere- in there you may or may not be getting wear and tear injury.

Your questions in bold.


Do you have any other suggestions specific to this tendon?

Nothing specific to that tendon, as opposed to any other muscle/tendon structure.


How long should it take to heal if I take the appropriate steps?

Depends. If you hit it hard with icing self massage (and ice massage) and take it easy on the legs running wise for a week, in the neighborhood of 2 weeks.

Longer if you self care less and/or run more.

It's a ratio of self care to how fast you 'heal' to how much irritation/strain you give to the structure while you treat.


And, I noticed that you say that rest alone will not heal tendonitis, but should rest be part of the therapy at all?

Rest won't help reverse the dynamic. But reduced irritation and strain will, obviously, reduce the amount of negative factors while you self care.

Usually I say, self care like crazy for 2-3 days while you keep things moving but don't really go run, certainly avoid any sensation of pain.

After that you can phase in running, and see how much you need to self care to keep the pain down.

Pain isn't necessarily a problem, as it's most just pain enhancing chemical released by the Process of Inflammation.

The trick is to NOT dial up the inflammation process, which makes you hurt more, makes muscles tighter, and pushes you towards the Downward Spiral.


Can I run on it if it is a little painful, or should I wait until it is completely pain-free?

It depends on how much you pay attention to it, how much you are willing to ice it and massage/stretch the structure(s).



Make sense?

More questions, more answers.


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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.

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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
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Comments for Posterior Tibialis Tendonitis, can I run if it hurts?

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Feb 13, 2011
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posterior tibialis and dancing
by: Anonymous

I am a dancer and i had/have the same thing. But i took off and i thought my tendonitis healed because it stopped hurting. But i started dancing again and it hurts.

Should i just get through the pain and just ice it often?


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Joshua Comments:

Yes, Tendonitis is tricky that way.

You've discovered that just because the pain is gone, doesn't mean that anything's any better.

Can you keep running on it? Yes of course. Will that make things get worse? Maybe. Probably.

Can you ice it like crazy and be able to continue to perform? Most likely, if you do it right.

You need to get enough pain out to be able to dance with a certain amount of irritation, and then after dance get to work on it to A. Eliminate all new irritation and B. Continue to make it happier than before that day's exercise.

Muscles are either tight or loose. The tighter they are, the less well they work, and the more problems they cause.



Mar 26, 2011
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Tibialis Posterior Pain?
by: Anonymous

Hi, I am a fairly new runner and believe based on the specific area where my tibialis posterior tendon is, that the pain I am having is being caused by this tendon. I am having trouble figuring out what to do though as it keeps coming back. Even from cross-country season to track season. I had to stop running during cross-country and thought it was shin splints at first but knew it couldn't be that.

What can I do to permanently stop this problem that keeps me from running?


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Joshua Comments:

First off, you can get the concept that the tendon isn't causing the pain. The tendon isn't the problem. The muscle that connects to the tendon is the problem. It's too tight, it's not working right.

It might not be the only one problem muscle, but tendon pain is just where the pain ends up. It's not the cause.


How to stop it permanently? I don't know. There are many factors involved and every person is different.

I would start you with a frozen water bottle and lots of fwb massage of the back of the lower legs.

See what happens, and let me know.




Feb 07, 2013
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Posterior Tibial Tendonitis
by: Anonymous

Hi,

I have had Posterior Tibialis Tendonitis for about three weeks but was caught up in a storm of mis-diagnosis: in week 1 I was told it was an infection, and was treated as such. In week 2 I was seen again and was told that it was tendonitis and told to rest, not to walk on it at all and use crutches.

I tried walking on it in week 3, as it looked fine, and by evening it had swelled up and was hurting (which it hadn't for over a week). Now, week 4, was seen by my doctor who said that I should not use crutches at all but walk on it instead as otherwise it will never heal; she said that to heal, the tendon will need regular blood flow, and to do this I will need to use the muscles, by walking on it.

Can you help me make sense of this? I walked on it yesterday and it did not seem to swell and it does not hurt.

Thanks!
I am a hiker and was about to take up trail running and I am keen to get going again.


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Joshua Comments:

Hi Anonymous.

What exactly has somebody think that it was an infection??

I'd need more information to have any sort of opinion.

1. What do you mean by 'swelling'?

2. What do you mean by 'it looks fine'.

3. Why did a doctor think it was an infection?

4. Yes, blood flow is important. But what caused this in the first place? How did it develop and progress? Details, please.




Feb 08, 2013
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Follow up to Posterior TibialisTendonitis and swelling
by: Enrico

Hi Joshua,

1. What do you mean by 'swelling'?

The ankle was initially very swollen and red around the bottom of the shin bone on the inside of the foot. When I said it swelled up again, is because the swelling had gone down by the end of the second week, that is when I walked on it. By evening, it had starting swelling up again; in particular, I could see what I guess is the tendon protruding between the shin bone and the heel. It was swollen and rather hard.

2. What do you mean by 'it looks fine'.

See above - not swollen and not red - looking normal.

3. Why did a doctor think it was an infection?

They thought it was an infection because of the following:
* I told them I did not twist my ankle, which she said ruled out a sprain (I had explained I had been trying to correct mu gait and felt I ight have put too much stress on the foot and that the ankle felt very much like a sprain)
* My foot "was very warm" and red
* I had a slight fever.
They run a blood test which showed low white blood cell count, which they took as confirmation I had a mild infection. (When I returned to the hospital and was seen by another nurse, I was told that the low white cell count was most certainly caused by mesalazine, which I take for ulcerative colitis.)

4. Yes, blood flow is important. But what caused this in the first place? How did it develop and progress? Details, please.

I believe this was caused by me trying to correct my gait/supination, meaning I had been actively trying to push down with the inside of my foot to place the foot more flatly on the road while walking. This overcompensation was agreed as likely cause by the nurse I saw the second time (the one who said it was not an infection but an inflamed tendon and advised me not to walk on it at all).

As per development, the first week I took antiobiotics and rested it totally for three - four days. Then, as the swelling subsided, I started walking on it, which I did for two-three days. A week after the first visit to hospital, the foot felt and looked felt "fine" - no swelling, no pain - but, as it was still red and I was told to inform them if the redness spread or did not clear, I went back to A&E.

There I was seen by another nurse and told it was tendonitis and not to walk on it. I used crutches and not walked on it at all for a week. Then tried walking on it one day and it swelled up again (as above). Returned to crutches only for about a week; two days ago, as the swelling and redness disappeared, I tried walking on it again.

No issues this time, but a very localized and minor redness. I went to my doctor yesterday who advised me to lose the crutches and walk on it. I walked on it normally all day yesterday and again, no swelling but just a very little redness on the inside of the foot/ under the end of the shin bone (I guess alongside the tendon).

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Feb 08, 2013
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Follow up Pt 2: Posterior TibialisTendonitis and swelling
by: Anonymous

-CONTINUED FROM LAST SECTION-

Hope this helps clarify the situation.
As per swelling, the ankle was initially swollen and red around the bottom of the shin bone. When I said it looked fine, I meant both the swelling and the redness had subsided and the ankle looked normal.


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Joshua Comments:

Hi Enrico.

Hmmm.

The plot thickens if you have ulcerative colitis, which means you have a lot of inflammation in your system, which means you're gluten intolerant and eating gluten, which means you probably also have
Leaky Gut (will open a new page from Kerri's www-easy-immune-health.com site), which means you're more nutritionally insufficient/deficient than you normally would/should be, which means you have a harder time fighting off inflammation and withstanding something as non-traumatic as walking a little bit differently.

1. How much gluten and processed foods to you eat?

2. Any history of ankle/leg injury?

3. How bad is your gait? Are you trying to add in a little correction, or a big correction?

4. Any other health issues?

5. Have you doctors ever suggested anything around diet or nutrition or nutritional supplementation for the ulcerative colitis?

6. Did the doctors offer anything to FIX the ulcerative colitis? Or just a drug you have to stay on long term?

7. Anything else interesting?


The swelling in the lower leg is not 'normal'. Either there's actually some rip and tear, or your body is kicking in an inflammation process that is WAY greater than it needs to be.

It's all good clues. And the more clues to help solve the mystery, the better.






Feb 10, 2013
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Follow up from Enrico
by: Anonymous

Hi Joshua, I doubt I am gluten intolerant; I do eat a fair bit of it but never had any problems, nor have I ever notice any pattern/relation flare ups/food. Doctors also said UC is unlikely to be caused by food (although have been advised to avoid non soluble fibres during flare ups). I eat v. little/no processed foods. I am on mesalazine long term, as in I was advised to take it until further notice and still am although last flare up in Nov 2011 (check up w. consultant long overdue)

2. Any history of ankle/leg injury?

Yes, left knee dislocation age 13 and 19, then operated (extensor apparatus realignment - rough translation) age 20. A number of ankle sprains (possibly due to supination?)

3. How bad is your gait? Are you trying to add in a little correction, or a big correction?

Had flat feet as a child, wore orthopedic shoes, now quite pronounced supination. Tried to correct it as experience sore/burning shin muscles when running and fast walking and read this likely to be caused by my gait.

4. Any other health issues?

No


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Joshua Comments:

Hi Enrico.

You said "Doctors also said UC is unlikely to be caused by food."

Unfortunately for you and millions of other people, your doctors are dead wrong. Please ask them to spend ten minutes researching the topic (as opposed to listening to other doctors that also falsely believe that ulcerative colitis is unlikely to be caused by gluten/gluten intolerance).

The research is clear. However, 'standard of care' and the pharmaceutical industry that teaches doctors willfully ignores overwhelming fact and research.

Gluten is an inflammatory agent.

Also, your doctors have proven that they can not fix your ulcerative colitis. It may be time to start looking for someone that can, if you're interested in a fix.

You said "I do eat a fair bit of it but never had any problems"

It's possible that's true, but as you have digestive tract issues, I highly doubt that it's true.

Certainly, you can get UC from other sources; nutritional insufficiency/deficiency, pharmaceutical medications, parasites, bacterial infection like h pylori, etc.


Feb 10, 2013
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Follow up from enrico, off crutches and now Achilles hurts
by: Enrico

Followed my GP advice and lost crutches and walked quite liberally on it Thu and Fri, started hurting yesterday (unfortunately I was away from home for the weekend and did not bring crutches along), really hurts today, tendon thickened and exposed just by shin bone.


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Joshua Comments:

What do you mean by 'exposed'?

How bad does it hurt?

Did you do any self care to have it hurt less, and if so, what?



Feb 11, 2013
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Follow up
by: Enrico

Exposed in the sense that is clearly visible under the skin. As per self care, I am using RICE, keeping the foot in an elasticated brace and reguarly using antinflammatory cream (ibuprofen) as well as arnica gel. I am going to start taking supplements as aminoacids, collagen, vitamins as well.


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Joshua Comments:

Hi Enrico.

I suggest that you get my Reversing Achilles Tendonitis ebook.

I don't recommend RICE, creams/gels or other anti-inflammatories (other than to get you through the day).

Vitamins etc, absolutely. I cover my suggestions in the ebook as part of the protocol.

IMHO you need a complete plan. A tip or trick just isn't going to cut it.

Targeting your nutrition supplementation is smart (as opposed to just taking 'some'), as well as targeting the self care to effectively deal with each of the necessary factors.






Feb 11, 2013
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UC
by: Enrico

As per ulcerative colitis, I have done quite extensive reasearch myself and all websites I visited (from WebMD to NHS, to specialist UC websites say the same the consultant I last saw said, the cause is still uncertin, but amongst the likely causes are immune system deficiency; extract below from WebMD:
Research suggests that ulcerative colitis may be an autoimmune disease. That means the body may be attacking its own healthy organs and tissues. Contrary to popular belief, neither stress nor specific foods actually cause ulcerative colitis. Yet, as you may have already found out, both stress and certain foods can aggravate GI symptoms.

In any case, I am not too concenred about this, as I have not had a proper flare up for over 15 months. What I am concerned about is my foot...


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Joshua Comments:

Hi Enrico.

Unfortunately, one can't necessarily separate the foot from other things happening in the body. If you have ulcerative colitis then your gut is operating less than optimally, you're not getting all the nutrition from your food, and you have increased amount of inflammation in the body.

That affects your foot structure and operation.


As far as WebMD etc, I agree, those medical sources all say that they have no idea what causes ulcerative colitis, that it 'may' be an autoimmune issue, and no clue why the autoimmune issue is there in the first place.

I assert that if you keep looking, you'll find LOTS of sources and research showing that A. gluten is an inflammatory agent, B. Gluten causes auto-immune issues, C. Gluten can be a causative factor in the formation and maintenance of ulcerative colitis.

I'm only pushing the point because if your lower leg isn't operating how you want it to, then one needs to find out WHY. And there are multiple factors at play, so some investigation and trial and error is called for.

And part of your scenario is the 'infection' symptoms. So you have something going on beyond simple tendonitis.



Feb 14, 2013
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Gluten doesn't cause inflammation
by: Anonymous

Hi Josh,

I have done further research and, apart from a small number of one-man websites and anti-gluten crusaders, I have found absolutely nothing to suggest that:
1. Gluten plays any part at all in causing ulcerative colitis
2. Gluten causes inflammation in anyone apart those who have intolerance or celiac disease (and I can tell you without the shadow of a doubt I have neither)

I totally agree with your holistic approach when you say that I can't separate the foot from the body, hence I started taking a number of supplements and antinflammatory foods (i.e. ginger)regularly and cutting down on a number of food which several reputable health sites I cross-referenced cite as possibly causing inflammation (and no, gluten was not on any of these lists), but - I am sorry - I don't buy into these anti-gluten crusades. As I said, I am Italian and I eat gluten regularly, in pasta, bread and pizza, and never have I had any sort of reaction to it that could suggest I am intolerant.

In any case, thanks for taking the time to answer my questions; I think I will just have to be patient and wait until I get an appointment with a podiatrist.


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Joshua Comments:

Hey Enrico.

No problem, we all do our own research and make our own choices.

I will say, though, that 'reputable' is in the eye of the beholder, and that in this particular case, the 'reputable' sources have no fix or cure for ulcerative colitis, just a lifetime prescription to pharmaceuticals. (Of course I'm making assumptions about the sources you're referring to.)

The proof is in the pudding, as they say.

I never had a problem eatinng gluten...until I did.

Regardless of gluten and focusing on the lower leg, you still need to make sure your nutrition is more than adequate (thus, therapeutic supplementation) and effective self care/manual therapy on the lower leg.

Let me know what the podiatrist says.







Jul 14, 2015
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Peripheral manifestations of UC
by: Anonymous

UC is a chronic disease that flares all over the body. It has caused tendonosis in my right foot with all the tendons inflamed at once. You are correct about gluten causing inflammation.

The only way to get it into remission is to permanent eat below 70 carbs a day, some think around 40 to reduce inflammation so you don't have flare ups.

It's a horrible disease and very poorly understood. Horses get a form of it and their hooves swell just from eating glucose rich grass and oats. Just wanted to say you are correct about gluten but it's also all starches if you have UC.

Of course this is poo pooed by gastroentrologists. They want you to take expensive medicine and get a dangerous exam every two years!



Jul 17, 2015
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Gluten and inflammation
by: Enrico

What evidence do you have about this? I did a lot of research and could not find any conclusive evidence that gluten causes inflammation.

I am not in favour of paying big money to pharmaceutical companies and would love top find natural remedies, but I got into trouble with my tendon in the first place by following some online advice to counter shin muscle pain.

The internet is a dangerous thing. If whatever is claimed is not backed up by solid research, I don't go touch it with a barge pole nowadays...


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Joshua Comments:

Hi Enrico.

I have a hard time believing that you haven't found any evidence of connection between gluten and inflammation if you've spent any time at all researching it.

Go to scholar.google.com

Put in something like 'gluten' and 'inflammation'.

Viola! All sort of research at your finger tips.

Having said that, I agree, due diligence is a good thing.

But the reality is, trial and error is a primary factor in finding what works.

What did you do to your shin/tendon for the shin muscle pain? Or at least, what was the advice that you followed?




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