Barefoot Running and PTT (Posterior Tibial Tendonitis)

by 353 · May 27, 2013 at 07:51 PM

Several months ago I pushed the barefoot envelope too much and developed a mild, but annoying, case of PTT. I continue to run barefoot (6-8 miles once or twice a week), but do all other exercises including my weekend long run in stability shoes. The stability shoes are driving me crazy and cause me to get really bad calf cramps on longer runs. Besides just stopping running does anybody have any strategies for dealing with PTT while continuing to barefoot it. If you're curious, the syptoms are mild, I am not overweight and I have good arches. Thanks!

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10 Replies

10170 · June 11, 2010 at 08:05 PM

Tendons that are a problem don't like to be used in a elastic/explosive way. Static or slow movements on the other hand are often no problem (even though the load is quite high). Tendinopathies also don't like compression. See research of Jill Cook here.

Practically this means:

  • be carefull with explosive/elastic movements (even though the load may be low). running is rather high tendon load, sprinting is obviously even more, and jumping and plyometrics.
  • don't do frictions or other massage techniques, they will only hurt.
  • and now for the single best exercise: stand on you toes and hold this position. Do this 4 times 1 minute, and repeat this 4 times a day. This is hard muscle work, but low tendon load, and it will decrease the hyperactivity of the tendon cells. If your problem is a tendon problem, this will work, rather quick!

If this strategy works, try to gently increase the tendon load by adding speed/explosiveness. Tendons heal, but slowly. Keep doing the exercise from above for a long time, even after the pain dissolved.


(fwiw, I'm a physcial therapist)

695 · June 12, 2010 at 02:06 AM

Pieter d has some good advice. Any type of tendonitis is an overuse injury and the only way to really treat is via resting, icing, maybe some NSAID's, and perhaps some physical therapy with video gait analysis if this seems to become a recurring injury.

I work in a PT clinic and see overuse injuries in athletes every day. Nobody active wants to be told to rest, but this is just your body's way of telling you to take it easy.

Don't look at this as a setback. It's a great chance to recover, avoid some adrenal fatigue, and even try out some new exercises you may have never done because you love running so much.

7709 · June 11, 2010 at 07:45 PM

Well, stop running :P

But that doesn't mean you should stop exercising. Why not try a strength program for a few months and then get back into running? You might find that your added strength increases your running performance, you'll give yourself time to heal, and maybe you'll strengthen the stabilizer muscles enough that you can ditch the stability shoes.

0 · May 27, 2013 at 07:51 PM

I realize this is an old post but I'll respond for the sake of anyone doing a google search and ending up here.

The posterior and anterior Tibialis muscles both work to invert your foot (they resist pronation). They both attach to your foot on your inner arch; the Tib anterior in front of the ankle bone, the posterior Tib behind the ankle bone, closer to your heel. So the posterior Tib acts more when your foot is pointed (plantar flexed), and anterior when your foot is dorsi-flexed.

I suspect the problem is that the posterior tib is acting too much at extreme dorsiflexion, when it should be relaxing and letting the anterior tib take over.

Whatever problem you have with your Posterior Tib probably involves your anterior tib too. Give your shin some good deep rubbing and I bet you'll find a sore spot there.

If it makes a difference, I am an experienced barefoot runner who has a lay-interest in leg anatomy and massage arts. I've read a few books on the subject (massage) and experimented with it on my own body for years.

334 · February 03, 2013 at 10:14 PM

I had Achilles and TP tendonitis at least a dozen times from too much chronic cardio. You need to stop running, otherwise it will go on for months and you will end up with lots of scar tissue and the likelihood of it coming back later will increase significantly. Do the right thing now and get it sorted out before you start running again. From my experience, the best exercise for most tendinopathies, by far, is eccentric loading/stretching. In your case, that would mean to contract the TP muscle by standing on the toes of both feet, with more load on the outside of your foot, slowly move the load of your body on one foot (affected leg), then slowly lower you foot until you go into deep pronation. Do this slowly. It's important to raise your body always with both feet, or even mostly with the leg that is not affected, because concentric loading of the tendon is not advised during the acute phase of the inflammatory process. The simple rule you have to follow is that everything you do should not be painful. If it's painful, it's too much too soon. Every time I tried to go too fast I ended up loosing months and it usually ended in me having to get a corticosteroid shot in the tendon sheath. That's not very pleasant ...

0 · February 03, 2013 at 09:30 PM

I have just been diagnosed with PTT and have had it now for a couple of months. I am trying to lose much needed weight so I have been going to the gym doing strength training with weights and "was doing some cardio dance classes" until it became too painful. Is the elliptical and bike ok? Can I still do leg weights? Can I do the treadmill if I I try to step on the whole of my foot rather then the ball? I am in a weightloss competion with a team so I need to be doing some form of exercise. HELP!!!

90 · October 02, 2010 at 12:23 AM

I would agree on your running technique needing work. Most people get up on their forefoot/toes too much and don't lower their hips/bend their knees and use their whole foot properly.

I'm #210 5'10" and have been running bare on road and trail 4 1/2 years with no problems.

Massage therapist/PT aide/personal trainer FWIW

20469 · October 01, 2010 at 06:19 PM

I have had tendonitis problems around the back of my feet intermittantly since I was 12. I am 40 now, so that is a long time! And it's only gotten worse with time. I try to stretch the muscles a lot and i am not a huge exerciser so I think the prob may be genetic. However, in recent few months, inspired by other paleo successes, I tried the experiment of going more natural. I now wear my vibrams hiking and I bought a pair of softsole moccasins for my work place where I spend a LOT of time walking around. Both types of shoes train you to pound your heal down less and to walk more naturally and correctly, as if barefoot. Seems like lately, the pain in the back of my feet is barely present, if at all, so I think it's working. Weeks now pass with no pain, and I've been putting in a ton of hours at work, which typically causes problems with my feet. I think I may be on to something!

0 · October 01, 2010 at 06:07 PM

From my own personal experience w/ self-diagnosed PTT, running absolutely barefoot (no VFFS) and being sure you bend your knees (not just a tiny bit, but so you feel your quads engage), taking steps low to the ground, and landing w/ midfoot (almost whole foot, not overly emphasizing the forefoot) allows the tendon to stretch appropriately. Picture yourself as a running Neanderthal. Running too straight up and down seems to compress the tendon and cause it to feel sore and uncomfortable.

0 · August 31, 2010 at 08:10 PM

I've also experienced the same thing as you are, and i had it for weeks. The only thing i did was stop what i was doing (i did heavy exercise like cardio, strength training and it really sprained my tendons) and gave it a rest. After a thorough check up with my doctor, i just took some medications to ease the pain, and it's not your typical OTC meds, some of it really costs alot and i'm finding other means to buy some "cheaper" ones over the net.

Hope i shed some light on this.

By the way, i also started a blog cause of this. Hope you visit my site too - thanks for sharing :)


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