Running Injury Advice

Posterior tibial tendonitis is a problem with the tendon on the inside of the ankle joint. The initial discomfort is usually felt either just above or just below the medial malleolus or inside ankle bone, sometimes extending down into the arch of the foot. There may be some swelling and more pain later as it progresses. The cause of posterior tibial tendonitis will be anything that overload the tendon. There are several foot types (eg a pronated foot) and running techniques (eg forefoot striking) that result in the posterior tibial muscle working harder.

My advice for posterior tibial tendonitis:

1. Restrict your activity levels to within tolerance (substitute some other activity like cycling or swimming). Use ICE and other modalities.
2. Get back to heel strike running to reduce the load on the tendon (you can worry about transitioning back to the forefoot later when it is all healed and the tissues have adapted to the higher load placed on them when forefoot striking)
3. Foot orthotics with the right design features are very effective at treating this problem. The foot orthotics has to be designed in such a way that they prevent the posterior tibial muscle from working so hard.

Long Term
After you are over the posterior tibial tendonitis, you can transition back to forefoot striking and away from foot orthotics very gradually and very slowly and very carefully so the tissues can adapt to the loads that are place on them. However, in some runners the loads causing the problem can be so high the tissues cannot adapt to the load. In that case, the heel striking and the foot orthotics need to be seen as long term options.

Resources:
26 yo with Chronic Posterior Tibial Tendonitis