Foot Fight: A minimalist runner’s road to recovery

How my posterior tibial tendon dysfunction could have been avoided, and why it don’t always gotta be the shoes.

VFF KSO

My feet used to be awesome.

After nearly two years of strong, minimalist running, they developed nice high arches, flexible toes and could happily handle all the bludgeoning that endurance and strength training threw their way.

Running used to be my strongest sport, and when I registered for Ironman AZ 2013, I was so jacked up to go out and dominate that I could barely sleep in the days that followed.

Excited, I kept training hard, set the course for the coming year and started to design my training plan.

But now, only a few months later, everything has changed.

My left foot is injured, deformed and sad. The right one is bored, both are weak and I haven’t run in over a month.

What happened? The short answer is that my left foot – which suffered a stress fractures last year – wasn’t ready to handle the long distances of the Ragnar Del Sol race. It’s misaligned and primarily hindered by posterior tibial tendonitis and dysfunction.

Many would argue that my injury isn’t surprising, considering my minimalist footwear.

However, it’s not the minimalist shoes’ fault. And to understand why, you’ll need to see the context of my injury and how I’m planning on overcoming it.

To start, let’s take a look at how we got to this point.

My Running Timeline:

Around age 3: My first memory and first taste of a running high: doing laps around the backyard, I look up at the stars and feel a calm awesomeness.
Footwear: Probably plastic sandals

Age 3 to 15: Grow to love baseball, and then basketball. These sports are the hub of my physical activity (and life). Any running is a result of either practice or games.
Footwear: Anything Nike (Nike’s marketing of the Air Jordans weighed heavily on my young, impressionable mind. I developed a basketball shoe addiction, highlighted by a messy temper tantrum in Foot Locker for a pair of the Air Jordan 6s. I would beg my mom for new – mostly unnecessary – basketball shoes every six months).

High School: Despite hours of unproductive weightlifting – bordering on being that guy at the gym – I learn proper running form through a great strength and conditioning coach. The key points: land on the balls of your feet, foot lands under the hip, nose over toes, steady, relaxed head, arms at 90 degree angles.
Footwear: Clunky basketball shoes

College to mid 20s: Exercise isn’t a big part of my life. The only running occurs when I’m late for class or about to miss happy hour.
Footwear: Don’t recall

Mid 20s: Start doing Crossfit workouts and going on a handful of three-mile runs throughout the week.
Footwear: Standard white guy New Balance running shoes

Laces

Late 20s: Read the book Born to Run and drink the barefoot Kool-Aide (gross!). I turn to Converse All Stars a few times a week as my first set of minimalist running shoes. After a few months, they become my everyday running shoes.
Footwear: Nike Free / Converse All Stars

Age 29 (Nov. 2011): Complete my first triathlon: Bluewater in 3:05:39
Footwear: Converse All Stars

Age 29 (Jan – March 2012): Slowly transition from the Cons to Vibram FiveFingers (VFF). After three months of easing into it, I’m a full-time, pseudo-barefoot runner. My toes feel like fingers, my arches are high and I never want to wear another running shoe again.
Footwear: VFF KSO

Stress fracture

Age 29 (Mid-March 2012): My first running injury: At the beginning of a six-mile, night-time run along a dirt path in VFF, my left foot slams down on a big rock. It stops me in my tracks, but I stubbornly, stupidly, keep running. On the same run, just before returning home, I jam my left big toe into the pavement. I know it’s bad, but the pain is just beginning.
Footwear: VFF KSO

Age 29 (April 2012): Despite the injured left foot, I complete the Lavaman Olympic Triathlon in 2:44:09. I can barely walk after the race and know it’ll be a long road back.
Footwear: Converse All Stars

boot

Age 29 (April 2012): MRI confirms a stress fracture of the second metatarsal. I wear a walking boot for six weeks. When the podiatrist discharges me, he doesn’t recommend physical therapy. In the same hurried breathe, he suggests orthotics and more stabilizing footwear. I explain my preference for minimalist running, and he quickly shrugs it off. After seeing how flat my left foot has become since wearing the boot, I ask for a prescription for physical therapy. He obliges – scribbling on auto-pilot – and scurries off to his next (surely nonplussed) patient.
Footwear: Walking boot

Age 29 (May 2012): Physical therapist actually listens and appreciates my allegiance to the barefoot philosophy. We work together for about eight weeks to slowly strengthen my left foot, leg, knee and hips. Despite our strategy to go the natural route, with the goal of getting back to barefoot running, her boss storms over on day 2 to sell orthotics (which makes the clinic more monies): after a one-minute assessment of my foot and leg, he dumps a bucket of big words and medical jargon at me, “shoots from the hip,” and vehemently recommends orthotics. I tell him that I’ve read a lot on the topic, and would rather try the natural route first. If it doesn’t solve our problem, I say, orthotics can be the backup. He backs down and after a couple months I am running again, and working out full force, pain free, without orthotics. In the end, my trainer agrees the natural route was the right call.
Footwear: Saucony cross-country racing flats with VFF sprinkled in

Age 30 (November 2012): Complete Lake Havasu City Olympic Triathlon in 2:52:08 – first in my age group (though it was a pretty small contingent)
Footwear: Saucony cross-country racing flats

Age 30 (February 2013): Run over 20 miles in about 31 hours in the Ragnar del Sol Relay. Arch collapses on left foot during my second leg, and the rest of the race is a painful grind. The inside of my left ankle swells up and hurts with every step; I shift the weight balance to deal with the pain, only to develop an ache on the outside of the left foot later on. A great time, but a major setback: after the race my foot is swollen, disturbingly flat and visibly misaligned. It’s clear my foot/leg had not built up enough strength to support that distance. Back to physical therapy I go.
Footwear: Saucony cross-country racing flats

Age 30 (Early March 2013): Go to a new sports therapy clinic recommended by friends and family. They’re sympathetic to my situation and not hell-bent on selling orthotics. Therapy includes many variations of balancing, stretching and strengthening exercises, along with ASTYM, ultrasound and even needling. We are making progress, pain is subsiding, but it’s a long slow road.
Footwear: Nike Free

Age 30 (Mid March 2013): Consult my second podiatrist, primarily for a routine administrative matter, and secondarily for a second opinion on the condition of my foot, and thoughts on my hopes for minimalist running. He said my Posterior Tibial Tendon is “diseased” and needs to heal completely before I run again, or I risk more complications down the line. All make sense to me. But then I hear that magic word again: orthotics. I question that tactic and he defensively snaps back, “Would you rather have surgery instead?” I tune out the next few minutes of his monologue (something about literature showing injuries in minimalist runners), and chalk another one up on the big board for closed-minded, orthotic-salesman doctors. I take his prognosis with a grain of salt, but it’s still a bummer to be told that your foot will never get back to the way it was (without purchasing orthotics of course).
Footwear: Office-wear dress shoes (I scheduled my appointment during a lunch break)

Age 30 (Late March 2013 – Present Day) At the recommendation my physical therapist, I swallow my pride and buy a pair of traditional, stability running shoes to take the strain off my aggravated Posterior Tibial Tendon, and help realign my foot. I die a little inside, but I secretly appreciate the comfort and support.
Footwear: Saucony ProGrid 6 8mm drop running shoes

Injury status

The posterior tibialis’s’s’sss main job is to stabilize the lower leg. It helps keep the foot aligned in a healthy neutral position, where body weight is distributed appropriately to the parts of the foot designed to take the impact (eg the arch). My posterior tib is “diseased” from tackling too much distance, too soon after an injury, and thus my arch is flat, my inside ankle juts out and my foot is misaligned. In addition, my stiff big toe is not helping to absorb the impact when the foot is in neutral position. This puts a beating on the outside of my foot.

It’s gotta be the shoes

No, Mars. This injury is a result of user error. My running form was fine, I was loving minimalist running and the shoes never malfunctioned. A few key decisions set me on a course for injury. I’m still a card-carrying believer in the barefoot, less-is-more philosophy. Orthotics would just weaken my feet, hinder our goal of strengthening the arch, and cost a boat load. However, I realize it’s gonna be awhile before I’m back in VFF.

Four lessons learned:

  1. No running at night in VFF
  2. Recognize the difference between being hurt and being injured. I should’ve stopped running and walked my sorry ass home after stepping on that rock in March, 2012.
  3. Don’t take on long distances too soon after an injury. My foot wasn’t ready for Ragnar Del Sol.
  4. Ween back into minimalist running shoes. Just because you used to go VFF 100 percent, doesn’t mean you can jump back in without skipping a beat. Take your time and pretend you’re a newbie.

Recovery strategy

  • Slowly heal and strengthen the posterior tibialis through a variety of balancing, band-work, single-leg squat and mobility exercises. Eventually (hopefully) it will grow strong enough to naturally correct the foot’s alignment and support the arch.
  • Go to physical therapy three times a week; receive ASTYM, STYM, ultrasound etc.
  • Do leg-strengthening exercises and mobility work every day (band work, foam roll, lacrosse ball, yoga, stretching, etc.)
  • Wear stability shoes while we’re in rehab, with the end goal of someday returning to VFF. Just say NO to orthotics dealers.
  • Tape the foot for added support
  • Ice the inside and outside of the foot every night
  • Keep asking questions and reading about posterior tibial dysfunction. Research new ways to help strengthen the foot.

Now it’s your turn. If you have your own posterior tibialis horror stories or thoughts on barefoot running and orthotics please share in the comments. I’d also love to hear any opinions on my recovery strategy and suggestions for getting over this injury.

– Live every day –

Adam

P.S. There’s a ton of information out there that supports both sides of the barefoot-vs-stability debate. Like many issues, we must choose what and whom to believe. From my experiences, I subscribe to the barefoot argument, but acknowledge that it’s not for everyone. The foot is incredibly complex and there’s no one-size-fits-all answer for everyone’s needs. I appreciate the discussion, and welcome respectful criticism or opinion, from either side of the aisle.

Also, I’m not a doctor or a trained medical professional. Please consult a credible expert for your own injuries and direction. Take my advice for what it is: a testimonial from an injured minimalist runner who can’t wait to get back out there.


UPDATE! See the latest in the Foot Fight saga in this follow-up post: Foot Fight 2

  • Roberto Alejandro Chupin

    Hi Adam, I have the same issue and started happening slowly after my bunion surgery. I kept telling the podiatrist that I had discomfort under my ankle but he just shrugged it off as a minor issue that would go away. Yeah… it didn’t :) so, I have posterior tibial tendonitis. I had an MRI done and showed no fractures. However, this issue still bothers me… While in the boot, did you experience weakness ? Did the boot help at all ? Did you prefer waking berefoot instead of the boot?

    Also, I think my orthotics are the culprit… I got orthotics 3 months before my bunion surgery because my podiatrist said it would be good to have :)

    • Hi, Roberto – During my six weeks in the walking boot my foot grew very weak. The boot functioned to take the load off my arch and forefoot and let the stress fracture heal. I didn’t walk around much barefoot during that time. Hope this helps, and good luck.

  • Megan Cannon LeVan

    Hello Adam! Thank you for sharing your story. I know this post is old, but it seems like you’re still responding to questions and I’m totally confused and overwhelmed at the moment, so I figured it can’t hurt to see if you have any advice for me. :-) I’m 33, not terribly athletic. I started running 7 months ago (Jan 2016) from scratch, with the goal of running a half-marathon 3 months from now (end of October). I tend to be a little bit “crunchy,” as my husband describes it, so I’ve been intrigued by minimalist running, but hadn’t tried it out yet.

    A few weeks ago, I developed pain after a run that would subside when I rested, and come back again after a run. The pain was on the outside of my right foot. I also have mild knee pain. I wanted to be proactive, so I went to an orthopedist, who said I hyperpronate – a lot – in both feet and that I have posterial tibial tendonitis in both feet. She prescribed braces, NSAIDS, and no running for four weeks until my follow-up appointment. She also gave me a list of supportive shoes and said I should be barefoot “only in the shower.” (I’m a homeschooling mom who prefers to be barefoot all the time. :-( )

    Now I’m worried about what’s going to happen at my follow-up. I like the idea of a more natural treatment plan, but I don’t know how to ask for it. I’m afraid I won’t know enough to push for it like you did. I also like the idea of switching to a more minimalist approach to running, but I guess I need to heal first? Any advice you could offer, just as a person with experience, would be appreciated.

    Thank you!

    • Hi, Megan – Thanks for sharing, and happy to help where I can. The “only in the shower” recommendation seems weird; however, the doctor might just be saying that to take the stress off your foot while it heals. If you’re in pain, you need to give your foot / PTT time to settle down before you can work on strengthening it back to normal. At this stage, it doesn’t seem like minimalist shoes would help because you should be focusing on resting, healing and strengthening before slowly working your way back to running pain free, and then making the transition to minimalist shoes.

      Also – and probably most importantly – what’s your running form like? Since you’re a relatively new runner, I would guess your form is the root of the problem. If your form is off it throws everything off, no matter what kind of shoes you are (or aren’t) wearing. Then again, it’s tough to say because I’ve never seen you run. As I mention above, you generally should land on the balls of your feet, foot lands under the hip, nose over toes, steady, relaxed head, arms at 90 degree angles.

      Hope this is useful. Keep us posted, and best of luck!

  • Mel G.

    Here’s my story with PTT…8 months ago, I increased my running mileage, while I was spending more time with light trainers instead of my usual maximalist shoes (Asics Cumulus). Then I began to develop medial ankle pain and swelling. Some days, I wasn’t able to run more than 1 km before being stopped by increasing pain. On other days, I could run 30 km with minimal pain. As a physiotherapist, I knew that it was a very bad decision, but I wanted so much to run Quebec Marathon, 3 weeks after the beginning of ankle pain. Att first, I thought it would be very easy to get rid of this injury (as I was used to!) but this one was so complicated to heal!! I ran it under 3h10, no pain at all. I had no ankle pain the days after the marathon. But I was never able to resume training seriously because pain became progressively worse. At one point, I had so much pain that I couldn’t walk without pain. And the pain began in the other foot. I tried 5 different exercise programs, ultrasound, massage, transverse friction of the tendon, tapings, orthotics, without a lot of improvement. At some point, the pain was so imprevisible that I wasn’t able to tell which kind of intervention was helping and which one was aggravating me. MRI showed signs of light tibialis posterior tenosynovitis without direct involvement of the tendon itself.

    So, I put a lot of efforts that didn’t help. BUT…I found 4 things that seems to help a lot:
    1-I received dextrose injections around the tibial posterior and saphenous nerve (perineural prolotherapy), a treatment that help calm down nerve inflammation. I had no pain at all during 3 days. Seems like it takes 6-8 injections before taking full effect and beat nerve inflammation in the long term. So, maybe some people with PTT symptoms without tendon damage have a big neural component that would respond to this kind of treatment.
    2-I began a gluten-free diet. It reduced my ankle pain from 50% (and a lot of other significative changes in my general health!)
    3-I did a lot of stretching of muscles that have a myofascial connexion with the deep fascia of the tibialis posterior muscle. I stretched the adductors, the hamstrings and the psoas.
    4-I did some neural mobilisations of the tibial posterior nerve: In supine position, I bring my hip in flexion while I keep my knee straight, then I point my feet outwards 10 times. It helps the nerve to move better between the fascias and interfaces.

    Actually I can run 10 minutes and bike 30 minutes in Cumulus Asics shoes and arch support. Pain is still there sometimes, but if I remember the time where I wasn’t able to make a step without pain, it’s a lot better than it was! I hope this post will help other people fighting with this nagging injury!

    • Thanks for sharing, Mel. Great to hear the pain is subsiding. I have no experience with dextrose injections, but I’m all about tips 2-4. Godspeed on your recovery.

  • Stacey Cerroni

    I know this post is a couple years old, but I’m glad I found it. I’m dealing with PTT that has sidelined me from running for 6 months. Did the obvious (no running, ice, rest, NSAIDs), wore various ankle braces, a surgical boot, KT tape, 4 different running shoes, insoles, arch support, and orthotic inserts, did PT, ultrasound, bone stimulation, MLS laser treatments, etc. So sick of it.

    I’m qualified for Boston ’16 and really want to train for it, especially since as I doubt I’ll ever get the opportunity again with this stupid injury. Is it too late to join the discussion?

    • Hi, Stacey – Too bad about your PTT troubles. You mentioned all the rehab stuff you did for your injury – I’m curious what kind of foot strengthening work you’ve been doing. For me, once the injury had healed, a solid physical therapy and foot strengthening strategy was the key to bouncing back the right way. Even though it’s a long, boring road to recovery, it’s worth taking it slow.

      • Stacey Cerroni

        Thanks for the reply Adam. My PT specializes in gait analysis for runners. He felt the tendon was too inflamed and sore to risk much stretching exercises, I’ve done some strength stuff for my calfs and for stability, but he focused on my “weak spots” – primarily glutes, and hips. This was to help my running form, but he and the Dr. feel my flawed “biomechanics” are main reason it’s not healing. Therefore the cause-effect won’t change since my foot structure is wrong. The key is trying to control the overpronation and irritation of the tendon by stabilizing it more.

        For a little background, I’ve ALWAYS had flat feet and been a runner my entire life. For years I used custom orthotics (from another run specialist) along with motion control running shoes, mostly Kayano’s. This served me well for years–until Asic’s changed their soles to cheap material that wore out like a pencil eraser. At $170+ a pair, I was fed up buying shoes every 8-10 weeks. I eventually began using Newton Distance with arch inserts. Very (very) slowly, I transitioned into them and was able to finally ditch the inserts. They felt GREAT and I ran my fastest races in them. Until…

        Last February, my left foot started hurting on my 2nd metatarsal. I rested it, iced, ultrasound, etc. After 7 weeks, I eased back into running and did a tough trail half marathon where I twisted my outer-left ankle. I had a really bad sprain and was certain the fracture returned. An MRI confirmed the stress fracture and inflammation on the anterior side, typical of a sprain, but nothing torn. I took a couple months off running and cross-trained with lots of biking and did bone stimulation 1-2x daily. After it healed, I began running, ramping up slowly. However, my ankle never felt totally normal, something seemed off, but it was tolerable… until an uneventful run where I felt a burning ‘pop’ in my inner left ankle like it was hit with a hammer. It swelled up, was red, and hurt with any inversion of my ankle. Ultrasound showed micro tears in the PTT, and another MRI confirmed “mild tendonitis” and a stress reaction in the tibial bone at the ankle.

        I quit running, switched to non-impact training, skipped a marathon, and began PT and treatments right away. The pain persisted so I even stopped cross-training. The PT suggested trying some running arch inserts with an ankle brace for walking. This helped while using them, but it still throbbed at night. I looked into PRP (opted not to bother), tried a half dozen MLS laser treatments with zero change, and was fitted for a surgical boot.

        Fast forward several months off: Boston Marathon in April and official training started Jan. 1. I decided to go for it, conservatively, easing into it, using elliptical or treadmill for less impact and only 1 outdoor (LSD) run a week. The long runs seem to kick it right back in though. Ugh! I’m still going to attempt to train for now, unless it gets a lot worse. If it’s that chronic of an injury (as it seems to be for most people), I may never be able to qualify again, or for that matter run another marathon again. I’m frustrated.

        Took 10 weeks off for the fracture, then 6 months off for PTT, and I’m STILL not 100%. I have an appt with an ankle surgeon in 2 weeks. I do NOT want surgery, but I want to know if there’s anything else wrong with it, and how to proceed.

        • Stacey Cerroni

          Sorry for long response. I just would love to hear that this pesky injury might heal one day. Seems no one really gets rid of it – for good at least.

        • Thanks for sharing, Stacey, and sorry for all those foot problems. It doesn’t sound like your ankle/PTT is strong enough for Boston, and I imagine pushing through would make the road to recovery even more difficult (my two cents; I’m not a doctor). Every case is different, and you seem to have a good grasp on the variables affecting your situation (e.g. running form, ankle strength, flexibility, time, distance). For me, the PTT issue is curable: I do foot/ankle mobility every day, and feel good when I run. At the same time, three years later, I’m still not back to where I was (left-foot strength wise) before the injury: it’s still noticeably deformed and flat compared to my right foot. I also still need to run primarily in stability shoes, though I try to work in a few light VFF runs here and there. So on one hand, I think there is hope for strong, healthy running after PTT. On the other, it’s a really long climb out of that hole, and you may be faced with a “new normal.” Hope this helps, and good luck.

          • Stacey Cerroni

            Thanks for your comments, Adam. Were you still able to do your IronMan race? If so, how did that go? Cycling puts stress on the tendon (albeit not the same impact), so I can’t imagine running a marathon after 112 miles. I may still attempt to train for Boston (knowing it will be my slowest marathon ever) just for the experience. I don’t think I’ll have another opportunity to re-qualify as this injury seems to be chronic and returns with increased training.

          • No problem, Stacey. Happy to help. I was able to bounce back in time for IMAZ. My marathon was slow, but it was an awesome race. If you’re interested, you can read my race recap here: http://triforles.com/af-race-report-ironman-arizona/

          • Stacey Cerroni

            Nice recap! You mentioned dealing with Achilles tendonitis going into your race, and only lightly mentioned an ankle issue, but not PTT. Do you have only a very minor case, or was your achilles that much worse?

          • Thanks. I had major PTT issues at the time of this post (which was about seven months prior to Ironman Arizona 2013). In the months following this post I recovered from the PTT. The Achilles tendinitis was a relatively minor issue that flared up later in the year, much closer to IMAZ. Fortunately neither of those issues (PTT or the Achilles) were major problems on race day. I’m working on a long-overdue update to this Foot Fight post that will provide more details on my PTT progress. Stay tuned!

          • Stacey Cerroni

            Good luck with the PTT recovery and all your racing endeavors. I finally got in to see the foot/ankle surgeon yesterday. He took x-rays and reviewed MRI’s and said a former bunion surgery I had is failing which is likely contributing to my problems. Good news is the tendon is now “inflamed and irritated,” but appears to be healing. He doesn’t believe the condition will be chronic if rested. I mentioned I have pain on the outside and back of my ankle that started after the sprain. He said the outer pain is scar tissue on the ligaments and cartilage. The heel pain is from “Os Trigonum Syndrome”, caused by an unfused bone in my heel that impinges on surrounding tissues. He said it was probably triggered by the trauma of the ankle roll/sprain. So as PTT goes, I now know it’s not the only reason for my ankle/foot pain. He said it’s a mild case. He said, “if you stop running, it won’t hurt.” So I guess I’ll just have to put up with some pain until Boston. ;)

          • Stacey Cerroni

            Adam, have you ever tried Glyceryl Trinitrate Patches? Some clinical studies have shown promise to accelerate healing tendons (though not specifically tested on post tib tendon). It’s not a cure-all, but looks to help. I am going to ask my ortho dr friend. He’s a 5x IronMan and Boston marathoner, so he understands the insanity of wanting to train (though his mantra is “Let pain be your guide”). For what it’s worth, here’s info on various tendon treatments efficacy from US Library of Medicine:
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505250/

  • Colleen

    Hi! I am currently struggling with posterior tibial tendinitis. I’m only a runner of 2 years. My fault was taking on too much distance too soon. I was never a runner or great as sports to begin with. My running form was pathetic at the time when I started and all my muscles were weak. I went through a stress fracture in each posterior tibial bone already. I’m fully healed but still dealing with terrible swelling and soreness after a run, walk or trip to spinning class to my left ankle. I am working with a Chiropractor to get me going again. I can’t run past 2 miles without pain. I am wondering if minimalist running on the side might help strengthen the muscle and get me further. Any advice? I am trying my best NOT to push my problem from the tendinitis mode to the dysfunction mode. I’ve taken on ankle strengthening (duck walks, heal lifts etc.), icing, massaging and I’ve added simple walking to my training schedule during the week. Thanks in advanced!

    • Hi, Colleen – Sounds like you’re approaching PTT recovery with the right mindset – essentially, taking it slow and easing back into running (reminder: I’m not a doctor). Since you’re still feeling pain, I’m not sure you’re at the point where minimalist running is the solution – but minimalist walking might be part of the process to get you there eventually. I think it all comes down to strengthening your feet and increasing flexibility in your ankles. Then, after a while, you may want to start easing into some occasional minimalist running. The other thing to keep in mind is that proper running form (e.g. landing on the balls of your feet, under your hips, tight core, etc.) is essential for pain-free running, of any kind, IMHO. So, I’d say your next steps would be to continue taking it easy, rehabbing, strengthening your feet (e.g. towel scrunches, heal lifts, ankle flexibility bends, etc.), walking barefoot and studying how to improve your running form. Best of luck, and keep us posted!

  • Bec_awesum

    I am so happy I found this. I’m rather at my whits end right now. I ran the Las Vegas R&R Half (my first) this past November. About 3 days after running it (2:22:14 btw) I noticed I was having limited range of motion, stiffness in my ankles. Took it as a post run thing. Flew back to Washington and ran (sort of) a 2 mile-ish shake out trail with my dog. On the walk back from the trail I noticed my right ankle was falling in with each step and also I had a foot drop I couldn’t control. Mind you I have high arches, they are not flat, at all. The Wed before Thanksgiving I went to the Dr who said I had PTT in both ankles and sent me to Podiatry. He then said to rest and NSAID the hell out of my ankles. After 2 months, still not better, so they gave me a huge walking cast boot for my right ankle (it’s worse). 2 weeks in that I go to PT, for her to tell me to ditch the boot. She applied manual release to the tendon and taped it and it felt amazing! I wanted to go running that week, but did not. I continue with PT to be told, I probably have Compartment Syndrome. (Oh freaking great!) The Compartment Syndrome explains the numb foot, drop foot and cramping calves I had all summer. But not the Post Tib Tendon pain. PT used the Graston’s method of using tools to “scrape” the fascia off the tendon. Felt great (not really) till she worked up my calf and was hitting the middle, then the Pos Tib Tend flared up again, only worse than the first time. I went to Ortho to get a 2nd Opinion, and she said’s yes to PTTD, cast boot on both ankles (only wearing one, I have 2 preschoolers to chase) and crutches. Now tomorrow, March 16th will be 4 months since I’ve ran my half, and nothing is getting better. I’m wearing my Asics, quit working out all together, and honestly with Spring blooming here in the Pac North West, I’m pretty bummed out I’m not running. Going to hold out till the first week in April with these damn boots and crutches to see what happens. LOL Lots of wine at night and tons of elevation.

    Thank you for posting this. I needed to read someone else’s struggle to get back into running.

  • Art Vzqz

    I have been diagnosed with pttd and really wish I would’ve recalled each step, including the fatal blow, as well as you have. i remember
    Noticing some swelling and bruising on the lower inside of my legs just above ankle back in June of 2014. I really didn’t think much of it, because it didn’t really hurt. I was dealing with what I thought was plantar facitis in both feet, but I still ran. I guess my ego kept me going. I did my last run, the Super Spartan, on Sep. 25th, 2014 and haven’t run since. My arches have not fallen, but my feet are pronating a bunch and it’s painful. It’s to the point where I’ve changed my normal gait, Due to the pain. Started therapy a few weeks ago and it seems to be doing some good. I’m hoping to be able to run again in the near future, however, I’m not sure exactly what type of shoe ill need.

    A little back story:
    I never had foot trouble before. Then, I had a knee injury that sidelined me for a bit. I was in the market for a new shoe and Was advised to go to a running store. I did and was given a video analysis. They said I overpronated and recommended a pair of Mizunos along with a pair of super feet orthotic insoles. I bought them, ran with them for awhile and my feet have gone down hill to my current situation.

    I’m pretty confused at this point about what shoes or if I need orthotic inserts in them.

    Just want to get better and run

    Thanks for your story

  • ivory88

    Hello there! Great indepth post. I enjoyed reading the play by play of advice given by MD’s and standing up for your own thoughts about your choices based upon experience. My story is a little bit long, but I’ve been researching this for some time so I’d like to put it out there. I had an issue with my right foot when I was a child (hereditary, my father had a complete club foot) where my foot turned in from the toes when I was just sitting, so when I walked I would trip on my own foot. After doctor’s advice was not working, my mom just bought me a good pair of Keds shoes and other than some obvious small issues with my heel dropping off a thin high heel or flip flop that never really bothered me, I was good to go for the rest of my life. I’m now 49, and going through my first foot “issue” (pain). This past winter was a really bad one here (Illinois), and we had deep snow and lots of ice for prolonged periods of time. I work at an apartment complex with people with developmental disabilities. I have a lot of walking, stairs, across yards and driveways to do, and attempting to navigate the mounds of snow and prolonged ice as well as support about 10 people with disabilities with maintaining their balance to come and go all winter, I began to get a pain in the inside of my right foot just under my ankle bone. It just felt stretched, and I ignored it, and each evening it would loosen up. Fast forward a few more weeks and I realized that the bottom of my foot (arch and outside of foot) felt tight and like it just wasn’t stretching as it should. Still I stupidly continued without attending to it in any way. I did notice my boots were getting looser, more play in the heels, which allowed my heel to drop over more, especially when stepping through uneven snow banks. Fast forward more, and I noticed I was getting pain on standing in the mornings (heel spur symptoms). Keep in mind, I’d never had to attend to pain before…and simply was of the mindset that when I had time I’d put it in a warm bath and massage it a little and all would be well and good…when I had time. So the winter ended, and I had a chronic issue. I changed shoes to this and that, trying to figure out what worked. But none of them gave me much relief, and would just move the pain to a different spot, so I’d get frustrated and switch again. I stretched the arches, but if it didn’t fix it in 2 days I’d give up. Always felt like the pain was going from the inside of the Achilles from my lower calf, down on the inside of the ankle under the ankle bone, and even was tight down the inside of my foot to my big toe. I finally did a search with the right symptoms and landed on posterior tibial tendon issues. Now after reading multiple “remedies” and scare tactics, I don’t know which way to go with treating it (I really don’t want to go to the doctor if I can just buy a certain shoe and do stretches). But I want to go the smart direction and not make anymore stupid mistakes that will send me backwards instead of towards healing. -Kathy

    • Thanks for sharing your story. Sounds like a tough situation, and far out my scope and experience, so I’ll leave this to the pros. One thing though: resting and strengthening the foot were crucial components of my recovery process. Stretching is also important, but it’s crucial to take the time to strengthen and rest the feet, and not to rush or go immediately full time and full throttle in minimalist shoes. Best of luck!

  • Swati

    Hi Luke, I just found out (a few weeks ago) that I have PTTD. It’s a very painful injury and I’ve not been able to exercise except for swimming. I have seen three doctors – an orthopedic doctor who put me in orthotics, which really didn’t work. Then I saw a foot specialist and surgeon, who put me in a walking boot, which was supposed to help my tendon to rest and recover. I was supposed to be in this book for 6 weeks. The pain and swelling did reduce, but after three weeks it is not completely gone. I know it takes a long time for the tendon to completely heal. In the meantime, I have done a lot of research and found the “Richie brace.” http://www.richiebrace.com/patients/subpage.php?page=pttd

    The Richie brace is a custom brace designed for your foot specifically. The doctor took a mold of my foot and ankle and had a custom brace built for me. This is my first week using the brace. But, so far, so good. It’s supposed to take 3 to 6 months for full recovery, but the doctor was very confident that my injury will be healed. I will also have to go through PT after my tendon is fully recovered. I will let you know, if you like.
    Thanks and best wishes. I can’t wait to go back to my exercise routine.

  • luke

    Great posts, thanks for all the advice. Im in a bit of a strange position. Im generally flat footed but have been wearing new balance supportive shoes with off the shelf corrective orthotics for the past year. Recently after quite a bit of training (normally alternate between 12 /24km per week) I have developed a sharp pain on the Inside of my left ankle. Trawling the net, it sounds like PTT, however I just got back from a 5km test run after 1 weeks rest and discovered something odd

    Whilst running and looking down at my feet, I discovered that I land on my heel and then shift my entire weight to the outside of my foot and then push off with my big toe. The pain on the inside of my ankle (the tendon) gradually builds until I feel as if something will snap as its so tight. Noticing there was alot of reliance on the outside of my foot, I removed the orthotics and intentionally forced myself to land on the inside / mid foot. This lead to instant relief.

    What does this mean? Being flat footed with a low arch lends itself to me requiring support, however if this is causing PTT then wouldnt i be better off using a neutral / minimal support trainer? To me this all sounds contradictory, I dont know what to do. I have a half marathon in 2 weeks and I really need to be fit for it. Do I stick with my supportive combo of new balance trainers and orthotics or go for a neutral trainer? Would a barefoot approach help as well? Any advice would be greatly appreciated!

    • Luke – Instant relief is usually a good sign, but I wouldn’t recommend switching over to barefoot or minimalist shoes so close to your race. I think that’d be too drastic of a transition, and would probably create even more problems. The happy medium may be to junk those insoles and train yourself to maintain good running form (landing evenly on the balls of your feet, rather than heel striking and shifting weight outside) in those New Balance shoes you’ve been training in. In my experience, proper form solves a lot of running problems.

      My feet used to be flat too, but after I (slowly!) switched over to the VFF, they grew stronger and developed high arches after about a year. So, keep it open as an option, long-term. The key to making this transformation is to take it super slow. If you feel PTT, or Achilles tendon pain, that probably means you’re rushing it. Thanks for reading, and good luck at your race!

  • Enrica

    What an interesting post! I hope your foot recovered. I have also been told that I have posterior tibial tendonitis. I started having problems after falling while I was wearing a pair of Dasko clogs, which were 1 size smaller (I was wearing small shoes for years!), while I was running trying to catch a bus, two and half years ago. The foot has never healed since then. I was told by all podiatrists to wear orthodontics and shoes with arch support. I ended up having too much support in men shoes (too large for me), which caused the posterior tibial tendinitis As a result, they put me in a cast twice (last year and this year) and twice my foot/leg became purple, I had to overcome over sensitization to pain (CPRS) in my foot and leg and I had to force myself to learn to walk again! This year I have been attending PT for almost 6 months, three times a week the first month, then twice a week, then starting from the third month, once a week. I did loads of ankle, leg and hip strengthening exercises, ultrasound included. I did not receive ASTYM and STYM. What are these? Are these techniques helpful?
    Now when my foot swells (particularly when the weather changes), I am still in pain, my foot feels not aligned and I have a painful needle sensation in the arch. The ankle does not feel normal, nor the blood circulation in my leg/food. I have a sunburn sensation (oversensitivity/CPRS) almost all the time, especially after I take a hot shower. My PT yesterday said that she no longer knows what to do to help my foot recover. She said that perhaps I should go back to wearing a cast to reduce the stress caused to the tendon when I walk. I am desperate. I have bought 20-30 shoes in the last two years but I can only wear a pair of old sandals with no support with little pain. I discovered that wearing socks only is the best thing I could have possibly done in the house. My foot hurts less when I remove my closed shoes. The Aesics stability shoes hurt my foot in the area of the arch support. A friend suggested I buy Converse because they have a flat sole, which forces my foot to walk almost barefoot. I am confused, desperate. I don’t know what to do next. Any advice would be so much appreciated! Thanks.

    • adamsfuller

      Enrica – I’m really sorry to hear about your foot troubles. Sounds like yours is a much different and more severe case than mine, and I’m nowhere near qualified to offer specific treatment advice. Have you consulted other therapists for second or third opinions? As I mentioned in my post above, working with a good therapist – who’s on the same page as you – can make a big difference. Ask a lot of questions, and see what they have to say about going the minimal-shoe route. There are lots of flat, zero-drop shoes on the market (I’ve worn Converse, Vibram and Vivobarefoot brands) so you have some options if you choose to give it a try. Again, I’m not a doctor, just tossing out ideas.

      ASTYM – in my experience – is when the therapists scrape the foot, leg and muscles to break up scar tissue and regenerate healthy tissue. It was pretty painful, but beneficial for me. Here’s a site I found with more info: http://www.astym.com

      Hope this helps.

  • Lauren Kelley Bond

    Fantastic post, Adam. Thanks! I’m a FiveFingers runner, too, and I credit minimalist running with helping my transformation from a jogging schlop just trying to lose weight into a real runner. I had my best run ever in a half-marathon a couple of months ago with the VFF Treksports.

    But that’s when I started noticing pain in my PTT. I think, really, it was training too quickly: I went from a only 3-mile runs to 7, 8, 9, and 10-milers in a couple of months, to make sure I was ready for my Tough Mudder. The Half-Marathon was less than 3 weeks after that. So, it’s clear to me why I’m feeling it now, despite not incurring any *obvious* injuries before or during the two events.

    Luckily, I’ve started reading up on PTT inflammation and am learning what to do for it before it gets any worse. Again, thank you for your post and rest up!

    • adamsfuller

      Thanks for sharing, Lauren. Sorry to hear you’re also dealing with PTT issues, but great that you’re getting out in front and approaching it with a
      level head. Sounds like you’re on the right track.

      Since this post I’ve been discharged from physical therapy and am slowly working back into running. I’m still in the stability Saucony running shoes – which I’ll most likely continue to wear through the Ironman race in November – and am jogging for about 20 minutes, 95% pain free.

      If I could offer any additional tips that have helped me, it’d be to continue to
      take it slow and light; stop if you feel significant pain in the PTT and take the
      next day off; and incorporate stretching, mobility and foot-strengthening
      exercises into your daily routine. Also, bike rides/spin class have been a
      great way to stay active and mobilize the foot, without putting the stress of
      running on it. Good luck!

  • Sarge

    Only you, Adam, can make a “foot fight” as riveting as good “knife fight” story. I feel your pain though, I am fighting off (by not really resting) a knee injury myself.

    • adamsfuller

      Feels like a knife fight at times: lots of stabbing (pain), dodging (overdoing it) and stealthy positioning. Maybe not so much that last one. Anyways, thanks.

      And take care of that knee, buddy! Looking for another strong performance from you at the next Ragnar.

  • Listen to your body! I have heard those words so many times that now I say them to myself. We can all be a bit obsessive about our workouts and set aside the aches and pains and push through it. However, an injury is an injury, and if you don’t take the time to treat, to listen, and to act, that injury just doesn’t heal, AND there is a real possibility for another body part, tendon, muscle, ligament or bone to get wrecked! Good for you that you are on the path of recovery! Great writing. I thoroughly enjoyed it.

    • adamsfuller

      Excellent advice, but so much easier said than done. If I would have listened to my body (and stopped running after my foot slammed on that rock), I’d probably be in a much better spot than I am now. When you’re working so hard power through, it’s easy to confuse good ‘ol fashioned pain with a debilitating injury. Something to keep in mind and continue to learn from.