Chronic Tibialis Posterior pain that has stopped a runner from running

by Linda Barnard
(San DIego )

I have been a runner most of my life. I am 40.

About two years ago my tibialis posterior started hurting and I have not been able to run since.

My one arch is dropping.

I have tried rest, othotics, strengthening exercises etc with no luck. My ankle is very unstable and I can feel the bones crack at times.

I have constant swelling around my ankle.

Any advice to cure this once and for all?


Joshua Answers:

Hi Linda.

Can I solve it 'once and for all'? Doubtful. I'm big on getting people out of pain, not so much on structural/muscle balance aspects.

Still, who knows, let's see.

1. Have you had this issue ever before in your running career?

2. How long has your ankle been unstable, etc? Say more about this.

3. Swelling around one ankle, or both. Say more about the 'constant swelling' part.

4. The arch dropping may or may not be a problem. Different for everybody. I'm not an expert on that aspect.....

5. In general, what does your dietary intake/calorie intake look like?

6. I wouldn't expect rest to help. Orthotics sometimes help, sometimes hurt. What -specific- strengthening exercises have you done?

7. Say more about your posterior tibialis pain and any other symptoms.

It always starts with more information. Let's see your answers to those questions, and we'll go from there.

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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Dec 15, 2009
Posterior Tibialis Tendonitis
by: Anonymous

Pain and swelling on left ankle at medial maleolus - and increases with any impact exercises such as running. Injury occured two years ago likely from running too much too soon. I eat healthy - high protein, no sugar and very natural. I am conscious of alkaline balance.

Any ideas on how I can fix this? I would love to run again.


Joshua Comments:

Hello Anonymous.

Is this Linda replying? I'll assume so.

The first thing I'm curious about is the chronic swelling at the ankle.

Get a 5 gallon bucket and Ice Dip as described on the How To Reduce Inflammation page. For 7 serious days of as many dips as possible, as far up the lower leg as possible. As many dips as possible.

After we do this we'll know how it responds to that. And if it decreases pain and swelling, as I expect that it will, then we can go exploring for any injury site/specific damage location.

It's possible it's just a stuck too tight posterior tibialis muscle. Still, first things first. Ice like a crazy person. Then get back to me with results and questions and we'll go from there.

Dec 23, 2010
I feel some sense of "Hope" after reading your website.
by: P.J.

I am like everyone else here. I have had a ankle issue that has turned bad and I feel helpless. I am 23 years old, male and I am in need of the right information to help me recover.

Tibialis Posterior is the tendon that is hurting me. I can no longer run. I have had this problem for 5 years. I have seen dozens of doctors. Dozens of PT's. Nobody has an answer for me.

I know you are familiar with the because I saw you mention that website in another comment.

That tibialis posterior problem describes the exact pain and symptoms I have. I have tried his cure, but it just feels like my tendon isn't awake (like I can't wake it up to do its job, to support its structure).

Every exercise I have found doesn't seem to help.

I have a knot(small ball of tissue)right below that bone on the inside of your ankle. It is in the spot where I first hurt my tendon when I was running back in high school. Whats my next step?

I am going to start on the ice tomorrow because that seems to be the first move. Then what? I am willing to do anything? I've lost my college football career because of this injury, but I don't want to miss out on any more years of running and playing basketball and doing the things I enjoy.

Exercises to strengthen the tibialis posterior?

Stretches? Or is the tendon overstretched?

Anymore info you need and I will provide!!

Thanks for your time,
P.J. Vallier


Joshua Comments:

Hi P.J.

Yes, I do like Bruce's EasyVigor content.

Here's my only issue with Trigger Point Therapy: There's more to the story.

Adequate and repeated trigger point work may be all a person needs. I'm curious exactly what you've been doing.

It's true that working trigger points does lots of good things, mechanically. But it may not be enough depending on what's going on.


What -exactly- have you done for this? How much, how often, etc?

Details details details.

Jan 01, 2011
Ankle pain description -- Chronic Tibialis Posterior pain that has stopped a runner from running
by: Anonymous

Lately all I have been doing is icing my ankle in a bucket of water 3 times a day. I have been doing that for almost a week now since I found your website. Before that, I tried orthotics which didn't do anything.

Then I tried different strengthening exercises that I would find on the internet but these exercises would not help. It always felt like my tendon wasn't awake, like I couldn't get it to fire correctly.

Now here's whats happening now. I'm icing everyday. And since I have started, I am feeling old pains in my ankle that I haven't felt for awhile. My ankle is very tender now. It even hurts to stand on it. The pain is in the same region where the tibialis posterior tendon runs on the inside of your ankle.
Is it normal for someone to feel more pain from iceing the ankle?

It kinda feels like the icing is waking up my ankle muscles where the injury originally occurred. Does that make sense?

I would try a Physical therapist but none of them seem to be familiar with my ankle injury. They just give me the typical dorsi flexion, plantar flexion with a band. And that doesn't work for me.

I'm sorry I didn't respond sooner. I didn't know you replied so quickly. Tell me what you think.

Lets work together to get this solved.

Thanks so much. P.J.


Joshua Comments:

P.J., that totally makes sense.

Your body feels and deals with pain long before it ever tells you about it.

So now you're stirring the pot, and paying more attention to your body.

So yes, there's more going on -and- you're feeling more. Literally.

I've been working on an old ankle/lower leg problem. As it was getting better, suddenly I felt the old sprain pain on a couple of ankle ligaments. It felt like I was newly injured.

But it gave me the visual of injury getting covered up by compensation, and then as we reverse the compensation and make things better again, we dig up the old injury. It probably doesn't literally work like that, but it makes sense to me.

Jan 01, 2011
Also barefoot running for foot pain -- Chronic Tibialis Posterior pain that has stopped a runner from running
by: Anonymous

I forgot and left out some stuff. I did try running barefoot to strengthen my feet. Even bought a pair of vibrams to run in.

I've tried Acupuncture. I've tried jump stretch bands that you use to do ankle exercises.

none of that worked. So right now all I'm doing is icing a bunch in a bucket and seeing where it goes from there.


Joshua Comments:

It takes time to create new foot patterns.

In short:

Build up slowly.

Line of force/weight big to to heel, not outside of foot to heel.

I used to walk run with my weight on the outside, pinky toe side of my foot.

Now I walk with my weight on my big toe side. My arch actually activates instead of collapses with each step.

And with the vibram barefoot shoes you may have noticed that muscles in your lower leg work differently.

And the more they work and turn on, the more they work and turn on.

The FAST way to turn on muscles that aren't working, as you describe, is with the ARPwave system.

When I was working with it to fix my ruptured disc, I started at my ankles. The first session turned my right ankle from a, for lack of better terms, a non functional structure (some muscles in my lower leg basically didn't fire so when I walked I just pivoted over my ankle instead of pushing off) to a firing with every step structure.

It was a pretty amazing experience. I didn't even know my ankle wasn't working right, cause I'd been walking that way for 30ish years.

I'm making a new page pretty soon with information on that. The ARPwave guys have an offer where they'll send you a unit and do one free evaluation and session (over webcam with you). If you're thoroughly impressed with the results, then you can sign up for more sessions. (contact me if you want do that and I'll give you some additional info you can use).

Point being, yes, you should ice, and dig around in there massaging then non-working muscle(s). You should be able to 'fix' yourself with time and effort.

And depending on what you're up to/motivated for, as I always say, there's the RIGHT tool for every job. The ARPwave system is the RIGHT tool for what you describe.

Sure, there's definitely a cost, but IMHO, the results are well worth it, and fast. Pay to play, as they say.

I'm leasing one long term and I'm totally restructuring my feet, legs, hips, back, etc.

Use the contact form if you're interested in more info.

Jan 01, 2011
by: Anonymous

I feel a lot better now knowing what I'm going through with the iceing is normal. I'm going to keep on that diligently. I'll work on the foot pattern well walking as well.

As far as the ARP wave system I'll look into it and see if I can invest in one to get the muscles working. But I do feel like i'm making some progress right now just from waking up new pains and I'm excited to see where this gets me.

I'll keep you updated where i'm at in a week and if I can start ARP system.

I'll let you know how it all goes. ICE ICE ICE.

Thanks so much for your help.



Joshua Comments:

Progress is GOOD!

Click the contact form on the left so I have your email and I'll get you more info.

Feb 16, 2015
My posterior tibial tendonitis seems to be subsiding but my ankle still swells.
by: Margarette

My name is Margarette and I have been diagnosed with Posterial Tibialis Tendonitis.

I have very flat feet so much so that you can see my entire foot print with both feet. The MRI only showed swelling of the tissue, no tearing. I believe it came from exercising in the wrong shoes because at the time, I didn't realize I should be in a specific shoe because of my flat feet.

I've been in a boot and doing RICE for 2 months now and the pain has subsided a great deal. I will be wearing custom orthotics in about a week or so along with supportive shoes.

I was told to go to physical therapy but it's too expensive, so I just do stretches and massaging on my own daily.

My question is if my tendon is healing, why am I still experiencing edema and soreness around my ankle and foot?


Joshua Comments:

Hi Margarette.

Here is the 'why'.

1. If a tendon has any actual wear and tear damage, that's just a symptom, not a cause.

2. There are multiple factors that make up the tendonitis dynamic. If the tendon is actually healing (presuming it was injured in the first place), the other factors are still in place. And they're the same factors that caused the tendon pain in the first place.

3. The Process of Inflammation causes swelling. Too tight muscles and connnective tissue tugging/pulling on things it shouldn't be can trigger inflammation.

If you didn't have flat feet before, and do now, it's because muscles in the lower leg aren't doing their job, and/or the plantar fascia has stretched over time as the arch and structures that support the arch have failed to keep the arch 'up'.

You can have severe pain with no actual damage to a tendon.

But ultimately, there are various factors that make up the Pain Causing Dynamic, and a collapsing arch is a symptom of that.

As muscles get tight, they stop doing their jobs (absorb force, and all that force has to go somewhere), and it all goes downhill from there.

No matter where the Tendonitis symptoms show up, it's all part of a predictible, progressive mechanism.

See: What Is Tendonitis?

See related: Posterior Tibialis Tendonitis Can I Run If It Hurts?

Mar 19, 2015
severe tendonis found by mri, will a brace heal it?
by: Anonymous

I was diagnosed with severe tendonitis, posterial tibial tendon tear, ( also had this 6 year ago) dr. Has me wearing a brace, and is giving me ultra sound treatmemts for 5 min., and electrode treatment for 10 min., three times a week, to heal and I have been doing this for 3 months now, along with rubbing area, and making it hurt, as directed by foot dr.

I still have pain in ankle bone area which happens more at rest, or just to flex my ankle. He says the brace is for weight bearing, so dont wear to bed. Which Leaves my foot to move around at night, which I wonder with doing this how can the torn ptt tear heel? I was born flatfooted.

I JUST NEED TO KNOW IF THIS IS THE RIGHT THINGS TO BE DOING...I would appreciate any advice you can give me. I wear custom orthodics but since wearing brace do not wear it on that foo as dr. Orders. He tells me I need to be patient but, I think after this much time I should be having less pain, and starting to heal...


Joshua Comments:

Hi Anonymous.

If you have a significant tear, then I can't see how a brace and ultrasound is going to allow it to heal back together.

Mostly, the doctor is trying to do as little as possible (maybe save you or the hospital money?) and hoping it will all work out (which, admittedly, it sometimes which I mean, your body will adapt so you're recover just enough to stop asking your doctor to fix you).

The tendon tore for several reasons. Those reasons are still in place. Why would the doctor think that partial bracing would help it heal back together?


Mar 25, 2017
Runner daughter with post reoccurring post tibialis pain
by: Anonymom

My daughter is a runner and began having arch pain after an indoor race on a banked track. After a few days rest she returned to train and two weeks later raced, pain returned again.

This process has repeated for the last 2 months with the last month having therapy and more rest.

Her PY says she's improving but she still seems to have intermittent pain (level3) no pain in exercises or walking. Just concerned about her healing as she is a committed D1 distance athlete.

Her 1st year is hard to miss but next year is more important to be healthy. Is some pain ok? She's had trigger point therapy and one session of dry needling. She uses ice and does strengthening exercises every day. Cross trains on a bike with no pain.


Joshua Comments:

Hi Anonymom.

A key concept here is 'healing'.

Does she actually have a rip/tear injury (which would require healing) or does she have pain with no injury(which does not require 'healing').

Chances are you daughter is having pain because of a lack of function.

1. If the muscle is too tight, it can't perform work nor absorb force like it's supposed to (and that force has to go somewhere).

'Strengthening' is neat and all, but it's unlikely she has a strength problem, she has an 'inability to function optimally/properly' problem.

2. If connective tissue is too tight, them muscles get stuck short (in contracted position, so can't lengthen/shorten/contract/relax appropriately).

3. If there's inflammation (almost certainly is), then that increases pain, which causes more tightness and eats up nutrition.

4. When there's lack of nutrition, then muscles literally can't relax, and Inflammation Causes Vitamin B6 Deficiency, and exercise further makes things tight and uses up nutrition...

It's a big Downward Spiral.

If she wants to be an effective distance runner, she needs her body to be able to effectively go the distance.

Right now, it's not able to do that.

Where is she getting the trigger point and dry needling done?

Mar 27, 2017
20 miles per week, what do you mean by nutrition for muscle pain?
by: Anonymom

She's having therapy (dry needling and trigger pt) at a Clinic and by a therapist who specializes in running.

She has also met with the university sports dr today and did an x-ray to be sure it was was.

He confirmed post tib but added some exercises for hip strength.

She doesn't seem to have any visible inflammation but sometimes she has that pain so perhaps she has it that isn't visible.

What do you mean by nutrition exactly?

She has gotten relief from the therapy on her calf to loosen the tendon.

She's about 80% better but taking it very slowly at 20mpw. The season is ramping up to state and her sr year but we are trying to be cautious and positive for the long game.

Any advice would be great.


Joshua Comments:

1. Ha. Sorry, I meant where on her body is she getting dry needling and trigger point work?

2. He confirmed post tib what exactly?

If the posterior tibialis is the problem, what exactly about it is the problem, and WHY is it the problem.

3. Yes, inflammation doesn't have to be visible to be actively active/causing a problem.

4. By nutrition, I mean, if her body doesn't have what it needs to work optimally, it can't work optimally, and to the extent it's not working optimally, it's going to (start) hurt(ing).

A. What is her Vit D level?

B. See: Magnesium For Tendonitis

C. See: Inflammation Causes Vitamin B6 Deficiency

D. I'd get her iron levels checked too.

Jul 05, 2018
Chronic Posterior tibial tendonitis and ankle sprain 1.5 yr ago, can't walk or stand without severe pain
by: Heba

Hi..I had an inversion ankle sprain 18 months ago and wasn't diagnosed or treated well at the first place..this led to repeated ankle sprains..and the diagnosis I had 7 months ago and Arthrography MRI is chronic ankle sprain in calcaneofibular and anterior talofibular ligaments with posterior tibial tendonitis.

I followed an intensive Physiotherapy program for 6 months and actually we had some good results at some times but I couldn't keep up any progress due to repeated inflamation that happens all the time with every little pressure or step on my foot and this prevented my PT doctor to go for next rehab steps and we stuck at a specific stage of it.
Symptoms: Currently, I have a real disability in weight bearing ..I can't stand without severe pain
Specific severe pain when walking..just when doing dorsiflextion at every step..
In repeated deterioration phases,pain is also existed even while sitting down.

I always use an ankle support and tried ice, contrast bath exercises and even apitherapy local injection beside PT and results are still unsatisfying at all and progress can't be maintained.

I was advised lately with shock wave, accupunture and PRP local injection. I'm also unsure if I really need to go for an intervention like PRP at this stage and whether it will be effective or not

I would appreciate if you could advise with the best and most effective therapy to get out of this dilemma ..I' m really exhausted from unsuccessful trials and can't cope with this disability.

Thanks alot.


Joshua Comments:

Hi Heba.

If the ligaments are stretched, that's permanent. PRP won't help with that (though can help heal and stretch damage and thus reduce some pain/pain signal...if there is any stretch damage).

The irritant injections into the ligaments MAY help shorten the ligaments a little. They have decent results but depends on your scenario.

IF the ligaments are stretched they there is a lack of/reduction of structureal integrity/joint support.

So then it falls to your muscle structures to provide that support. Having said that, your ligaments may not be stretched but long story short the muscles aren't working correctly and that's why the constant pain/repeated strains.

You may want to get busy working with the Reversing Achilles Tendonitis program (it covers the entire lower leg so don't get caught up on the 'achilles tendonitis' part). Once you read through it my recommendation should make a lot more sense.

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