As an orthopedic sports doc triathlete with my own troublesome PTTD, this is best video for I have seen addressing critical strategies for recalcitrant cases.
@@eddieolachia5305 3-6 months is a good estimate for how long it takes to calm down a tendinopathy. For my proximal hamstring tendinopathy, it took about 2-3 months, for my patellar tendinopathy, it took a good 7 months. I've had PTTD for about 2 years now, it has gotten better, but I still get flare ups. I've also had painful psoas tendinopathy for over 2 years now. You just have to play the long game and be diligent in your regimen. You can even do periods of NSAIDs plus icing every 2-3 hours for a couple weeks to really hit that inflammation and see if you can do a 'reset' on the tendon. It is not recommended to keep taking NSAIDs for long periods of time, and if you find yourself absolutely having to do that to function, it's probably best to see a podiatrist to get some expert help. It takes only weeks to feel gains in muscle strength, it takes up to 1.5 years for a tendon to be helped by exercise. Massaging it and using it in non painful ways will help get blood to it and hopefully heal up.
I am 87 years old, 50 pounds overweight, and have had both knees replaced. I also have flat feet and was given orthotics that seemed to hurt more than helped. In March, as part of attempts to get into better shape, I started walking in my home to get aerobic for 20 minutes. I was walking a straight line from kitchen to the back of my house, about 20 feet,back and forth, and also around my large kitchen island clockwise and counterclockwise. I woke up one morning, with my right ankle on fire. The pain went under my ankle bone on the inside and down under the arch. Research told me it was posterior tibialis tendonitis. My primary care doctor thought it might be gout and prescribed anti-gout medication which (of course) did not help at all! In the last few months, I have lost 15 pounds and am on an anti-inflammatory diet, which has helped, but I still have really bad days!
I have this pain under my ankle the hurts a lot if I stand in one place for too long, it feels swollen and the dull ache really bothers me and you’ve really nailed the symptoms as I feel ok to walk just not standing still. It’s been about a week in and I will listen to your advice and try to offload it by resting on the bed! Thank you so much!!
Great video (the previous one on this issue also)> I have had the same experience re standing too much, tight shoes, stretching causing more pain and found a different way to stretch. I also watch the slant of the road as I walk or hike. Your videos are the first ones to address these issues. Thank you. I would also like to mention another problem I had after wearing a prescribed orthotic for over a year. I lost my ability to walk barefoot into the swimming pool. I solved this by walking barefoot with support for 2- minutes twice a day and changing my shoes and orthotics two or three times a day. The original orthotic had "frozen" my foot. The small amount of barefoot walking (now I need no support) and the changing of shoes and different orthotics (purchased over the counter) solved this problem. Thanks again for the great video!
Great video indeed, thanks a lot. Most other physiotherapists over there upload a set of strengthening and stretching exercises, advising that you practise them daily. In my personal experience, if you're not patient enough until the injury calms a little down, these exercises and stretches may be quite irritating.
Absolutely and you should never do strength training daily - the body requires time to recover and adapt and you will often just make it worse if you do it daily. xm
True my physio says I should start strengthening all the time, even after I mentioned I still feel pain n at the end after I make this point to him he goes well it’s your ankle do what’s good for you.... it’s sad, but after resting it for just for 2 weeks now n removing all tensions to it it got a lot better as the pain went away by so much but I guess I gotta keep on resting until it’s even more better simultaneously do stretches n then only try to do strengthening
I always stand way too much due to back pain and nobody has diagnosed me w tibial stuff til now, everyone else treated me for plantar fasciitis, etc. and I never knew this could happen, I'm almost stage 3 and praying for recovery - arches are caving in. TERRIBly painful, didn't know not to static stretch the calf - THANK YOU!!!
I think you gave me my life back here! I do not do aerobic workouts and do not run. I developed PTTD as a result of long periods walking around the house.Hard surfaces no shoes,more in house time with the pandemic. The people(MD,PT,DPM,DC) I consulted all tried really hard to help me. And the deep massage/mobilizing with the Graston gives temporary relief. But the advice to keep going with the custom orthotics even though it hurt more with them on. That only made it worse(came from two of the professionals,not all ). There really is a compressive component to the pain. And I found at the end of the day sitting wasnt enought to give relief. I had to take my shoes off. I stopped using hard custom orthotics which were compressing the tendonmore and stopped the painful exercises (I still do ROM exercises) I walk only with soft over the counter inserts in good running shoes on. Even in the house. And I added wearing compression socks 24 hours per day. The latter has made a huge difference,i cannot believe how much! I am now getting better daily, after sufferring with this for almost six months thanks to this post of yours! Maybe when the pain has been gone for a long time I will strt using the orthotics agaijn in a preventitive capacity. Ron Tennenhouse MD
You might recognize my user name as I’ve watched basically all your videos after running the gamut of ankle and foot injuries. Peroneal tendons, Achilles tendons, bone spurs, metatarsalgia, plantar fasciitis, sinus tarsi, stress fractures, and now this. This is a huge pain in the a because it’s present at rest and there’s no break from it. Had it for 5 weeks now as a post operative complication (surgery on the other foot.) all of this started with a short course of fluoroquinolone antibiotics. Anyway, I will try these next. It’s hard not to get discouraged but I thought my metatarsalgia would never heal, but at about 3-4 months it finally did. Just wanted to say thanks for these videos. They really provide a lot for you getting little in return.
Excellent information specific to this injury. Absolutely worth finding someone who truly understands this specific exercise. Less strengthening and more stretching helps me more than anything. Plus wearing Birkenstock shoes or insoles...a MUST for this injury.
This was really helpful, I'm trying to find exercises to do at home while I wait to see my PT in a couple weeks. Was so upset and freaked out (thinking omg what if I've caused a rupture) when I realized I was flaring again and couldn't figure out why. I just tried band exercises for the first time, I had been moving my ankle side to side unbanded for weeks without pain so I thought it was time. Clearly not based off your advice, I probably need to hold off longer. Literally the pain is right near that medial malleolus bone. So helpful to know what I can do to calm this back down again aside from my insoles and Rx orthotics I'm getting in a few weeks. Validating and reassuring, thanks so much!
Thank you so much for this and the other video ( how to get rid of PTT) as it explains now why my current exercises are painful and I am not making progress. Great explanations ! I will seek the help of a sports medicine physician .
Thank you so much! I've struggled with foot pain for YEARS. Now I know what I have and how to work on it. I have a good local physiotherapist, so looks like I'll be seeing her for possible dry needling. Fun times.
Fantastic video! This is 💯 me! I had an injury a year 1/2 ago and also have low back issues added with fibromyalgia 😩 3rd ortho diagnosed me with this and then some such as slight tear in ankle. I am going to PT found a great place sports PT who also do dry needling which you mentioned. Mine is not a sports injury just an injury (perhaps walking a lot on vacay where I fell and that aggravated my legs due to flat feet )added with tear, lumbar issues, and flat feet 😩 I have ortho inserts invested in good sneakers however I started walking local gym and helped back but not shins, ankle and or feet. You are 💯 correct with amount of time on your feet. I noticed that lately …. I have to find time to sit and rest. Nighttime is the worse but I think that’s my back. I’ve had MRI dopplers PT and what you recommend is the best advise I’ve seen on YT. Thank you!!
Hi there, One of our team of physios would be happy to assess your injury and provide you with a personalised rehab plan. You can find more information here: www.sports-injury-physio.com/
Great video - I've been having posterior tibial tendonitis pain for 5 months now. I am a 24-year old athletic male. I believe I injured it while slightly misstepping during a run outdoors. Since, it aches often and limits me. Can no longer run or jump without major discomfort, however, I can do a tippy-toe walk. I've had 3 months of physiotherapy, mainly trying to strengthen it, however, maybe some slight progress, but the discomfort still present. I am going to inquire about to get an ultrasound to see the severity of it, but very frustrating. Is the healing process typically this long?
I'm at 13 months now, still can't run. A few times I've gotten it almost healed and then overdid it. Each time it seems recovery is slower than the last. I think the trick is to be SUPER careful and very gradual.
6 months into it and I can totally relate to you guys... nearly fully healed but I overdo it then it gives tension to it so I get pain again.. I love this video cuz it focuses on leaving your ankle for rest “no exercises, cuz to bring tension to it” after that slowly start stretching but “not strengthening yet” I’m doing this atm and I’ll slowly will start to put strengthening exercises but not yet as I’m not ready yet cuz I do feel my ankle is recovering & still feels somewhat in pain. It’s sad many physios don’t really keep in mind how much of recovery is important before moving into strengthening even when you explain them that you’re still feeling pain. Love this video cuz for me, leaving my ankle alone for now 2weeks is feeling way better than I’ve ever felt but I still got long way ... plz let me know how you guys got back to normal it’d help a lot
@@rosan932 going through this. Very very frustrating ! 8 months now. Did everything. Stopped walking other than daily house and community walk. Icing, arch support, new shoes, custom orthotics. The inflammation has come back this week with the show rubbing on the tendon !
6 months on the wagon train for the lion kingdom. Lately noticed the insertion point starts out painful but the pain goes away after running a mile. Wasn't sure if the neurons were shutting down or if mobilizing it was beneficial.
Reading here to learn more, weighing in to say compression socks would help for really short periods of time when I know I was swelling. I would take them off often. Now that Im out of that acute phase I don't really see swelling but I don't bother anymore.
Wow, thank you such great advice, I have been having foot and ankle problems for some time and its has only been diagnosed as PTTD. Unfortunately I have to stand and walk for long periods of the day as I am a school teacher and walk/use public transport. I am going to use this advice to try be lazy where possible and sit down and work. And I will but a new pair of shoes tomorrow.
Stand with a small hot smooth rock under your arch for a few minutes. Definitely helps my arch and ankle relax. Developed my tendon troubles from a trip from a stumble and misstep in a hole while running through a field.
So, I've had this problem with my tendons in both feet for years but never knew what was going on until I started researching because I am currently in a boot for three weeks because I ended up with a bad case of tendinitis in my left foot. I say for years because I am a caretaker/homemaker and the long hours of standing in the kitchen would just tear me up on the bottom of my feet in the arch area but I didn't know why, the walking to do grocery shopping and such isn't too bad unless I was with others and ended up doing walking and stopping and waiting and walking, stopping, and waiting, etc. Then I would come home and my lower legs and feet would ache for days. Last Sept. I had a bad sprain and a small fracture on the outside of my ankle where the tendons attached and was in a boot for a couple months and felt great afterwards. I tried doing the band exercises but found them difficult on my own and finally stopped thinking my dance fitness classes were enough but apparently the weren't helping. Question: you say that shoes/insoles are important, if I am at home and needing to stand for an extended period of time should I be wearing shoes? I usually go barefoot. The other question is do you have a video or videos on the progression of exercises I should do so that I don't have this happen again in the future. Thanks.
@@Ashish-nd3xj Found out I had two tears in my post tib and they did major surgery - basically 3 surgeries at one time. I'm now out of physical therapy and doing better. But I really wish I had known these things before.
@@grannysquareswagonwheels2604 so sorry to hear about your surgery. Glad to know you are recovering well. If I may ask at what age did you start to see the pain and how old are you now. I am just 39 and have had multiple ankle problems since last 4/5 years ! Use custom orthotics. Felt well for a few months but now the pain has come back ! Did your physio therapists and doctor say you would walk normal now ?
@@Ashish-nd3xj I don't really remember when it started but I was in my early 40's when I started working where I was on my feet all the time and then it kept getting progressively worse. I quit working outside the home and started watching my grandbabies and then it lessened because I wasn't on my feet all the time, not because I was exercising/treating them. Then the last 2 years I noticed it was just painful standing in the kitchen and so I was doing some general exercise but it exacerbated it instead of helping it. I wish I had gone to the doctor earlier and had him send me to physical therapy so I could have learned the proper exercises to help. I am nearly back to normal now but will continue foot and ankle exercises to prevent needing any surgery to my other foot. I am 54 now.
@@grannysquareswagonwheels2604 that's nice to hear that you have had a successful surgery and recovery. I am just too worried about this injury which started while running a few years ago. Yes, the physios talk about the ankle and other exercises but I don't know how much they help. Just like you, i didn't know for long what was happening. Just the last year a podiatrist diagnosed with this and asked for an orthotic. Do you use orthotics now ?
Im battling w this issue, running a half marathon on Saturday and its frustrating not able to push, I also work standing in a cardiac cath lab where I stand wearing 20lb leads on😊
I knew my foot was damaged but had to walk for 2 more months and then I couldnt walk. HOW LONG do I have to stay off of it? I am 4 months in. Moon boot next and I don't know how long to stay off it. I have crutches but I walk all the time and move stuff all the time.
Thanks for the video. I will try these strategies. I have been dealing with this pain for several months. The pain jumps around from the sole of my foot, to the inside of my ankle, to the post tib tendon area near the ankle to my achilles tendon and even into my calf. What does it mean if the pain jumps around like that? Could it be an issue with nerve compression rather than actual damage in all of these areas? If rest the best approach for nerve compression? Thanks!!
It does sound more like a nerve injury (not compression necessarily). Rest is not always the best treatment - it depends on what is irritating the nerve. It may even be coming from your back. So, the best course of action is to get it assessed by a physiotherapist and get tailored advice. If you want help with your rehab and an exercise plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
I think it's important to wear some type of orthodic that is posted so that if overponation is part of the cause for P TTD it. Stops the ankle from everting. I am going through This myself and I'm having a very hard time dealing with it emotionally because I can no longer walk properly. In addition nobody talks about getting Internal tibial rotation as the ankle weakens and pronates even further. My altar sounded revealed I have damaged in my Posterior tendon and calcification. I also have functional Leg length discrepancy which could be part of the reason why I overponate more on the longer side. I How? Been going to physiotherapy and feel that none of the treatments are helping even though I have gone Three different physiotherapy places. I don't think they really know how to deal with this condition and are giving me the wrong exercises. My foot doctor actually said it is okay to walk on my ankle even though he knows there's damage to my tendon. I cannot believe he would give me such ill advice. My authorities dig into my feet so horribly and of course arthur wearing my body a little bit off balance I am so uncomfortable. I never expected to lose my mobility without being an accident. This is a horrible debilitating condition that I never knew about. I could go on about doctors and other medical professionals. Should Patients be braced so that their tendon can heal? If so what type of Brace is Required to give the tendon a break? And do these tendons really have the capacity to heal When they've been stretched from overprognation? It doesn't seem plausible to me. It seems that surgery is the only way to go. The wait list for an orthopedic surgeon in canada is over a year long.
Im a runner, or used to be at this point. Been dealing with this for 8 months. Going crazy. Pain when standing now, just took a big step back. Hoping to find an answer soon.
Ugh - that is frustrating. If you want help with your rehab and an exercise plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
Hi there, We consult with many patients who are in the US. I don't personally do consultations anymore, but you're welcome to book a video consultation with one of my colleagues. If it's tibialis posterior tendinopathy that's your issue, Kevin's your man (but they're all very experienced). More info here: www.sports-injury-physio.com/
How do you feel about oral corticosteroids for this condition in a low dose? I have posterior tib tendinosis and a grade 1-2 strain in the distal/medial aspect of my soleus and gastroc. Thanks
Shoes are a personal thing, so you have to try them before buying but usually Asics and New Balance make good shoes - ask for medium or strong support when you go to shop depending on your foot/ankle mechanics + bodyweight.
@sportsinjuryphysio No matter what Bob & Brad say you are the best PT on the internet. I just switched to trail running from many years of road running and developed this condition, occasionally my left leg/ankle just seems to lose all control and power for a second and I almost go down. It comes back to normal right away, is this a symptom of this condition or something else?
🙃Thanks - I think you need to get it checked because this is not a typical symptom or thing that my patients with Tib Post injuries report. A leg can sometimes give way like this when a joint is injured or when a nerve is not 100% happy.
An excellent video. Thank you so much Maryka.. Two short questions: Can you please recommend some glut. exercises to help and secondly will the APS machine help this condition.? Thank you so much.
Check out Bret Contreras for more than you ever wanted to know about glute training. My partner and I have both seen great results using his recommendations.
what are treatment options after you have had surgery for pttd? .I still have pain in my foot and tendons, pin in my heels and other stuff to give a small arch.
The main treatment would be a carefully graded strength training plan but other treatments like custom made orthotics to support your arch and tendon and PRP injections may also be useful - your doctor should also be able to advise on this.
Excellent video. My injury is from March 10 and the inflammation is focused on the insertion of the scaphoid bone (it seems that it came out much more inward). I am resting a lot and with ice 3 times a day) Just on April 26 I do an MRI. Can cordoned neoprene anklets help me until I have an accurate diagnosis? Walking crookedly is causing pain in my spine. Thank you so much!!! My name is Adrian and I am from Argentina.
Hi Ive found this useful but my mri shows longitudinal rupture of post tib and the pain has been there for over a year Tried physio n pain meds n arch But nothing seems to work Standing is an issue Pls can you guide me 🙏🙏🙏
Very useful video and knowledgeable presenter. Thank you. I had been considering different options for this long standing issue and your insight and thoughts has covered a lot of what I had wanted answers or information on.
Thank you so much for sharing your knowledge. I do get relief from dry needling but I feel like I need to strengthen because the pain comes back. Does the banded dorsiflexion exercises help where you pull the top of foot straight up towards hip? I’ve read a study that recommended that as one of the treatments, but don’t understand how this would help.Thanks again.
Hi, these videos have been upser helpful so thankyou! My podiatrist has been no help over the last 3 months. I get better then something happens and Im back to it being bad. I was doing relativley well last week with some rehab exercises but one day woke up in a lot of pain and a lump I think where the tendon attached to the foot and it stings. This seems to come and go depending on pain. Any idea what this may be and if its ok to try and hand / tennis ball massage out?
Hi there, We cannot provide individual treatment advice without doing an in-depth assessment of your injury and your personal circumstances, as the advice might not be appropriate for you. You're welcome to book a video consultation with one of our physios if you would like an assessment and a personalised treatment plan: www.sports-injury-physio.com/
I've had this for six years now, and counting. It has really messed me up. Nothing works. Plus all the several physios I have seen always seem to fixate on my problem being insertional achilles. OK maybe I have that as well, but that's not where it *really* hurts. All the time. Complete rest (for months) doesn't help at all. Exercises can certainly make it worse. Walking can make it worse. Running ... just a little bit, not necessarily bad.
Hmmm, yes, if your main pain is not actually at the insertional Achilles but rather this, then this is where the treatment should be focused. If you want help with your rehab and a treatment plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
Foot drop is usually linked to damage to your nerve that supply the Tibialis Anterior muscle resulting in the muscle not being able to work. In addition to doing dorsiflexion (lifting your foot as you walk) the Tibialis Anterior is meant to work together with the Tibialis Posterior to support your foot arch and stop it from rolling in. If your Tib Ant is now not working, the Tib Post and other muscles in that area might be overworking and that can result in cramping. So, you might actually benefit from arch support (orthotic insoles) and some strengthening exercises for your foot in general but it obviously depends on the finer details of your specific situation.
It really depends on your current injury state + the actual cause of your specific case (anatomical vs. just weak muscles vs. lax ligaments) + what activities you plan to do in them - they have very little support so if yours is currently injured they will likely just make it worse. But once fully recovered you could use them to strengthen (only if your foot shape is right - if flat feet then likely will continue to aggravate) but you will likely be at higher risk of reinjury if you do any activities that push your body into fatigue because at that point your muscles won't be able to provide as much support to your ankle and it will then also not get support from the shoe = more likely to cause trouble.
Very informative video. Please give me some advice regarding my situation. It took 6 months for the swelling of my inner ankle to go down due to post tib injury. Once the swelling was gone. I had noticed that my foot had taken on a different shape. My navicular bone is much more prominent now. I assume it's because the tendon is now healed into an elongated position and not putting enough tension to support the arch. I now struggle to walk with the collapsed state of my foot although pain is minimal. I do regret not having worn a moon boot, for I've put a lot of stress on the tendon with my lifestyle. But now I am afraid I have caused permanent damage and will not be able to walk or run normally again. Is it possible for the tendon to pull tighter on my navicular bone and lift it back to its normal position?
It is difficult to provide a definitive answer without actually assessing you but often the only way to know if it can improve is by working on it and seeing what happens - it takes months of exercise + correcting your foot posture during the day to see results (if possible). In my experience it usually requires a combination of: 1. Custom orthotics to help support the tendon and arch while you work on strength 2. Doing strengthening exercises - here are some ideas: ruclips.net/video/5ompYPEHbyM/видео.html 3. Making sure your wear supportive shoes If you wanted help with your rehab and an exercise plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com/
Kills me stood in one place I have osteoarthritis in both feet flat foot both feet planta fachitis & spurs on both feet I tripped of 2nd stair at bottom of my stairs at home I've seen 3 phiso 2 padiatrist they think it !aybe paroneal tendanopathy ime now having a m.I.r. scan in July complete agony cannot walk at all the left foot has become bigger than other foot I cannot work like this I done this October 2020 its been 8 months CNT cope much longer when I sit for a while I go to get up & the foot won't move not even one step same when I get out of bed its like it sieves up they wnt give me pain killers as ime on tramadole for my osteoarthritis I have crutches I cannot walk up stairs where I cannot bend feet never been able to go up stairs 8 months I wish I cld walk I limp over to one side so much pain please help and advice.
Hi! Found your video trying to get some information about post tibialis tendon issues. I started having pain in the plant of my foot and immediately though about plantar fasciitis. After a few days of stretching and exercises I noticed it didn’t get better and contrary to what happens with plantar fasciitis first steps in the morning were bad but it tend to get worse during the day when walking. Haven’t been running of course... went to have some personalized orthotics and the pain on the plantar fascia is almost gone but the area of the post tibialis tendon and navicular is somewhat tender to the touch and gets irritated with activity. Would really appreciate any advice. Thanks in advance!
I’m wondering if my recent effort to practice heel-toe walking as aggravated my Post Tib tendon. Is this muscle involved in the windlass mechanism? I’ve been progressing slowly in minimalist shoes even forefoot walking for 3-4 months. But I experimented with some heel strike walking with greater foot flexion than I was getting from forefoot walking. The other variable is that I also experimented with a TENS unit. Not sure which to blame most.
It can irritate the tib post but I am wondering if you've not perhaps aggravated your Flexor Halucis Longus tendon that runs from the big toe and along the same line as the Tip Post. It is often overworked when people try and push off more pronounced with their big toes which I think may have been the case with practicing your walk pattern and because the tendon runs so close to the Tib Post is is often mistaken for Tib post tendinopathy but it is actually FHL.
I HAVE A BIG QUESTION FOR YOU THAT PEOPLE WILL PROBABLY LIKE TO KNOW. Mine is on inside of ankle been going on for 12 months now and on inside of ankle . with all the exercises I've been doing i have shoe insert in but i feel like my better leg is shorter than other and hip ache on better leg like its shorter than other is this normal. the side the ankle is bad has hurt my knee to not tracking under knee cap
I can't really answer you without assessing you and seeing what is actually going one. It sounds as if you can benefit from seeing a physio who can look at your whole body and check what may be affecting it.
I have this injury 5 weeks. Didn't even notice it at first so continued running on it. Now very weak, swollen and even bruising sometimes. Question - can I swim (pushing off walls?) and/or use a turbo trainer?
In my experience cycling often makes it more aggravated at the start. I would start with a swimming session where you don't push off the wall and then observe how you feel in 24 hours after. Then test one where you do push off the wall and observe how it reacts. That should give you the answer as to what yours is happy to do at this moment in time.
Twisted the ankle and tore the tendon 6 years ago. Hasn’t been the same since. Inner tendon is aggravated whenever I walk on uneven ground for even as little as one hour.
@@Ashish-nd3xj I found that constant stretching and strengthening of all muscles around the ankle has made a world of difference. If I’m inactive for even a couple of days everything tightens up. It takes a lot of work to keep the tendons stretched out and supple. Better than surgery though.
@@Ashish-nd3xj No longer wearing orthotics. I did for a while until the muscles were strengthened. Yes, I had an MRI. The tear healed. I still have residual pain, however, if I don't continually stretch and strengthen the ankle.
That's a hopeful story for me. Really nice to hear. Please be careful with it and don't overdo. Keep waring orthotics if you can. How much time did it take you to recover (complete rest in boots/cast ?) from it at the time of initial tear. Sorry if I am bugging you
What if my ankle pain has completely gone away; it used to be my ankle area and the bottom of my feet; it’s been 2 years since I was diagnosed and I’ve done the exercises. Now the bottom of my foot is what hurts.
I’ve been struggling with pttd in both feet since may of 2022. I have foot leveler orthotics and day braces on both feet. Dr currently has me on anti inflammatory medication day 3 and still sore. I work a pretty sedentary job/lifestyle so don’t understand why this is happening. Weekends I spend a lot of time cleaning and standing in the kitchen. I know I need to lose some weight which probably isn’t helping but kind of difficult when you can’t move. I also have si joint problems. Any advice you can offer would be much appreciated.
It may help to strengthen the muscles that support your feet. It can also help to generally become more active doing exercise like swimming, or exercise classes in the swimming pool or using a stationary bike. If you do introduce new exercise it has to be done slowly and gently with short sessions and enough days recovery between sessions. If you do carry a few extra pounds, then losing those will also make a big difference as, besides the fact that it causes extra load on the tendons, being overweight also can lead to increased pain levels. But I realise this is not a short term solution as it can be hard to lose weight.
Has anyone tried the PRP for this? I had one but it came right back. I think I started my barbell training too quickly. I’ve dealt with this for a year and can’t do The recommend reconstruction surgery. I’ve tried off loading some but I think need to give that better focus
Hello! I have an MRI diagnosis of insertional tip post tendinopathy. I have seen the MRI and it's the sheath of the tendon that is inflamed (not the whole tendon), where it inserts on the navicular bone. In fact, this was mistaken for a navicular stress fracture by two podiatrists (they thought they saw something on xray) and ended up in a moonboot for months until I insisted they order an MRI after literature consensus said navicular bone injuries must have MRIs. In a podcast from Sean Docking tendon researcher in AUS, he said sheath tendinopathies (in general) are a friction issue, not a compression issue, but in your videos you say research say tib post it's a compression issue. So my questions are: 1) do you treat insertional tib post tendinopathy the same way as in your videos, 2) any comments about an inflamed tendon sheath being a frictional issue? Thank you!
I have to be honest, I've not had anyone where they have been that specific with the diagnosis in that they've identified it to be just the sheath that is the issue. Friction and compression tend to go hand in hand. That part of the tendon naturally experiences compression and friction throughout walking, running etc. and it is only when this becomes excessive that it is a problem. I'm not sure how you would tell if it is friction more than compression that is the problem and I would argue that by addressing the compression component you will also tend to decrease the friction. I treat patients according to their symptoms and how their injury react when we try out different exercises as well as what their biomechanics look like. My treatment programmes are rarely the same for 2 people with tib post tendinopathy as no 2 people ever have the same circumstances, built and activity levels. Does this make sense?
@@Ashish-nd3xj Hi there, I am not 100% but my post tib and foot are highly functional meaning I can run, hike, ski, bike. But if I go over my current limit that I've trained for, yes I will start to become "aware of it." I haven't and an acute flare up in months thanks to proper rehab and managing my loads, the latter being very key. I still rehab my calf muscle as this is happening on my ACL reconstructed leg and calf muscles is critical overall.
Not sure if anyone will ever see this comment but I was wondering if anyone has swelling with posterior tibial tendinitis? I have a running injury from a year ago, had an MRI after 5 months of not getting better. Was told anterior, posterior, and ankle tendinitis along with shin splints. I have a knot near the post tin muscle belly and swelling, especially after exposure to heat and or exercise. Tried therapy to no avail. Anyone have a similar experience?
Please be honest, are people suffering from PTTD better off just getting surgery? I feel like the excercises havent helped and i just wasted a few months
I've not had any patients who needed surgery. Sometimes the exercises can actually be the reason why it stays aggravated. So, if they are not helping I would stop doing them and see what happens if you just really take care of it and try to take the strain off your tendons by wearing sensible shoes and limiting time on feet. If you see it starts to calm down, continue that approach and then just super slowly increase time on feet again over time but always focusing on the best shoes and support you can give the tendons. Injections can also be useful add-ons for stubborn cases.
And I think you e explained why everything I think injured my top foot did. Loose shoes, barefoot climb up an aluminum ladder with week foot muscles and leaning into my right toes and into left inner foot because of a stroke. Therapist said I don’t know where my shoulders are so it’s hard to be standing correctly.
Hi Kunjal, We cannot provide individual treatment advice without doing an in-depth assessment of your injury and your personal circumstances, as the advice might not be appropriate for you. You're welcome to book a video consultation with one of our physios if you would like an assessment and a personalised treatment plan: www.sports-injury-physio.com/
My PTTD started imroving rapidly when started wearing precription below knee compression stockings. It reduced the swelling a lot. Mind you I have been wearing these 24 hrs per day. But has been worth it. The pain improved a lot within 24 hrs of starting to wear these. This goes along with the PT on this site saying there is a "compression" component to the pain of PTTD . RT
Maybe, it's compression against the bone, where bad rubbing happens, that we're trying to avoid with tib post x ankle bone. At least, that's my understanding.
A doctor said: your face is really red. He sent me to an oncologist who told me you have polycythemia. Have you been skiing or chasing your dog? A sign of polycythemia is an abnormally high red blood cell count.
Of course there's hope! Get help from a physiotherapist - they can help you understand how to overcome this. If you want help with your rehab, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
This is just nonsense...most people stand on their feet for over 12 hrs a day for work...then we go and run for 2 hrs everyday! And workout for 2hrs a day. Sitting is just not an option in real life!
I have had three ankle injuries since October 2019, the last one being this august 2021. I am still having pain while standing due to tib post tendinopathy. Would you recommend I try to stop doing the inversion/eversion exercises over going into an aircast for 3 weeks? I have started in an aircast since Thursday (4 days ago)? @sportsinjuryphysio
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As an orthopedic sports doc triathlete with my own troublesome PTTD, this is best video for I have seen addressing critical strategies for recalcitrant cases.
It help you any?
@@eddieolachia5305 3-6 months is a good estimate for how long it takes to calm down a tendinopathy. For my proximal hamstring tendinopathy, it took about 2-3 months, for my patellar tendinopathy, it took a good 7 months. I've had PTTD for about 2 years now, it has gotten better, but I still get flare ups. I've also had painful psoas tendinopathy for over 2 years now. You just have to play the long game and be diligent in your regimen. You can even do periods of NSAIDs plus icing every 2-3 hours for a couple weeks to really hit that inflammation and see if you can do a 'reset' on the tendon. It is not recommended to keep taking NSAIDs for long periods of time, and if you find yourself absolutely having to do that to function, it's probably best to see a podiatrist to get some expert help. It takes only weeks to feel gains in muscle strength, it takes up to 1.5 years for a tendon to be helped by exercise. Massaging it and using it in non painful ways will help get blood to it and hopefully heal up.
I can tell you really care, thanks!!
I am 87 years old, 50 pounds overweight, and have had both knees replaced. I also have flat feet and was given orthotics that seemed to hurt more than helped. In March, as part of attempts to get into better shape, I started walking in my home to get aerobic for 20 minutes. I was walking a straight line from kitchen to the back of my house, about 20 feet,back and forth, and also around my large kitchen island clockwise and counterclockwise. I woke up one morning, with my right ankle on fire. The pain went under my ankle bone on the inside and down under the arch. Research told me it was posterior tibialis tendonitis. My primary care doctor thought it might be gout and prescribed anti-gout medication which (of course) did not help at all! In the last few months, I have lost 15 pounds and am on an anti-inflammatory diet, which has helped, but I still have really bad days!
I have this pain under my ankle the hurts a lot if I stand in one place for too long, it feels swollen and the dull ache really bothers me and you’ve really nailed the symptoms as I feel ok to walk just not standing still. It’s been about a week in and I will listen to your advice and try to offload it by resting on the bed! Thank you so much!!
You're welcome!
Great video (the previous one on this issue also)> I have had the same experience re standing too much, tight shoes, stretching causing more pain and found a different way to stretch. I also watch the slant of the road as I walk or hike. Your videos are the first ones to address these issues. Thank you. I would also like to mention another problem I had after wearing a prescribed orthotic for over a year. I lost my ability to walk barefoot into the swimming pool. I solved this by walking barefoot with support for 2- minutes twice a day and changing my shoes and orthotics two or three times a day. The original orthotic had "frozen" my foot. The small amount of barefoot walking (now I need no support) and the changing of shoes and different orthotics (purchased over the counter) solved this problem. Thanks again for the great video!
Thanks for sharing...helpful for those of us just starting recovery.
Great video indeed, thanks a lot. Most other physiotherapists over there upload a set of strengthening and stretching exercises, advising that you practise them daily. In my personal experience, if you're not patient enough until the injury calms a little down, these exercises and stretches may be quite irritating.
Absolutely and you should never do strength training daily - the body requires time to recover and adapt and you will often just make it worse if you do it daily. xm
True my physio says I should start strengthening all the time, even after I mentioned I still feel pain n at the end after I make this point to him he goes well it’s your ankle do what’s good for you.... it’s sad, but after resting it for just for 2 weeks now n removing all tensions to it it got a lot better as the pain went away by so much but I guess I gotta keep on resting until it’s even more better simultaneously do stretches n then only try to do strengthening
@@rosan932 how are you doing now. My thing has come back again
@@rosan932 how did you rest it completely for 2 weeks ? Like a boot or something ?
I always stand way too much due to back pain and nobody has diagnosed me w tibial stuff til now, everyone else treated me for plantar fasciitis, etc. and I never knew this could happen, I'm almost stage 3 and praying for recovery - arches are caving in. TERRIBly painful, didn't know not to static stretch the calf - THANK YOU!!!
I think you gave me my life back here! I do not do aerobic workouts and do not run. I developed PTTD as a result of long periods walking around the house.Hard surfaces no shoes,more in house time with the pandemic. The people(MD,PT,DPM,DC) I consulted all tried really hard to help me. And the deep massage/mobilizing with the Graston gives temporary relief. But the advice to keep going with the custom orthotics even though it hurt more with them on. That only made it worse(came from two of the professionals,not all ). There really is a compressive component to the pain. And I found at the end of the day sitting wasnt enought to give relief. I had to take my shoes off. I stopped using hard custom orthotics which were compressing the tendonmore and stopped the painful exercises (I still do ROM exercises) I walk only with soft over the counter inserts in good running shoes on. Even in the house. And I added wearing compression socks 24 hours per day. The latter has made a huge difference,i cannot believe how much! I am now getting better daily, after sufferring with this for almost six months thanks to this post of yours! Maybe when the pain has been gone for a long time I will strt using the orthotics agaijn in a preventitive capacity. Ron Tennenhouse MD
Any updates to your comment? Wondering how it's been going. Hope it's better.
You might recognize my user name as I’ve watched basically all your videos after running the gamut of ankle and foot injuries. Peroneal tendons, Achilles tendons, bone spurs, metatarsalgia, plantar fasciitis, sinus tarsi, stress fractures, and now this. This is a huge pain in the a because it’s present at rest and there’s no break from it. Had it for 5 weeks now as a post operative complication (surgery on the other foot.) all of this started with a short course of fluoroquinolone antibiotics. Anyway, I will try these next. It’s hard not to get discouraged but I thought my metatarsalgia would never heal, but at about 3-4 months it finally did. Just wanted to say thanks for these videos. They really provide a lot for you getting little in return.
You're welcome, and good luck with your recovery!
How do tell difference between tib post and tarsal tunnel?
and FHL tendonitis
Thank you for explaining this so thoroughly.
You're very welcome!
Excellent information specific to this injury. Absolutely worth finding someone who truly understands this specific exercise. Less strengthening and more stretching helps me more than anything. Plus wearing Birkenstock shoes or insoles...a MUST for this injury.
Very informative and useful
Thanks for posting
My pleasure
This was really helpful, I'm trying to find exercises to do at home while I wait to see my PT in a couple weeks. Was so upset and freaked out (thinking omg what if I've caused a rupture) when I realized I was flaring again and couldn't figure out why. I just tried band exercises for the first time, I had been moving my ankle side to side unbanded for weeks without pain so I thought it was time. Clearly not based off your advice, I probably need to hold off longer. Literally the pain is right near that medial malleolus bone. So helpful to know what I can do to calm this back down again aside from my insoles and Rx orthotics I'm getting in a few weeks. Validating and reassuring, thanks so much!
Thanks for watching, and good luck with your recovery!
Best video for this injury. My physio went straight to the exercises, every day. Now it is worse. Going to have to stop.
Omg, what a great, in-depth video. I'll stop some of the exercises that I'm doing after seeing this...
Thank you so much for this and the other video ( how to get rid of PTT) as it explains now why my current exercises are painful and I am not making progress. Great explanations ! I will seek the help of a sports medicine physician .
You're welcome!
Thank you so much! I've struggled with foot pain for YEARS. Now I know what I have and how to work on it. I have a good local physiotherapist, so looks like I'll be seeing her for possible dry needling. Fun times.
Good luck with your recovery!
Thank you so much, I learned a lot from this video!
I'm so glad!
Fantastic video! This is 💯 me! I had an injury a year 1/2 ago and also have low back issues added with fibromyalgia 😩 3rd ortho diagnosed me with this and then some such as slight tear in ankle. I am going to PT found a great place sports PT who also do dry needling which you mentioned. Mine is not a sports injury just an injury (perhaps walking a lot on vacay where I fell and that aggravated my legs due to flat feet )added with tear, lumbar issues, and flat feet 😩 I have ortho inserts invested in good sneakers however I started walking local gym and helped back but not shins, ankle and or feet. You are 💯 correct with amount of time on your feet. I noticed that lately …. I have to find time to sit and rest. Nighttime is the worse but I think that’s my back. I’ve had MRI dopplers PT and what you recommend is the best advise I’ve seen on YT. Thank you!!
Thank you for sharing your knowledge . I have tried everything. I'm not sure where to go next. Any help would be greatly appreciated
Hi there,
One of our team of physios would be happy to assess your injury and provide you with a personalised rehab plan. You can find more information here: www.sports-injury-physio.com/
So helpful, thank you so much.
Great video - I've been having posterior tibial tendonitis pain for 5 months now. I am a 24-year old athletic male. I believe I injured it while slightly misstepping during a run outdoors. Since, it aches often and limits me. Can no longer run or jump without major discomfort, however, I can do a tippy-toe walk. I've had 3 months of physiotherapy, mainly trying to strengthen it, however, maybe some slight progress, but the discomfort still present. I am going to inquire about to get an ultrasound to see the severity of it, but very frustrating. Is the healing process typically this long?
I'm at 13 months now, still can't run. A few times I've gotten it almost healed and then overdid it. Each time it seems recovery is slower than the last. I think the trick is to be SUPER careful and very gradual.
@@andrey_climb_bike_ski Good call.
Will surgery work I’m going through the same pain bro, it’s really getting on my nerves
6 months into it and I can totally relate to you guys... nearly fully healed but I overdo it then it gives tension to it so I get pain again.. I love this video cuz it focuses on leaving your ankle for rest “no exercises, cuz to bring tension to it” after that slowly start stretching but “not strengthening yet” I’m doing this atm and I’ll slowly will start to put strengthening exercises but not yet as I’m not ready yet cuz I do feel my ankle is recovering & still feels somewhat in pain. It’s sad many physios don’t really keep in mind how much of recovery is important before moving into strengthening even when you explain them that you’re still feeling pain. Love this video cuz for me, leaving my ankle alone for now 2weeks is feeling way better than I’ve ever felt but I still got long way ... plz let me know how you
guys got back to normal it’d help a lot
@@rosan932 going through this. Very very frustrating ! 8 months now. Did everything. Stopped walking other than daily house and community walk. Icing, arch support, new shoes, custom orthotics. The inflammation has come back this week with the show rubbing on the tendon !
Brilliant thank you.
You're very welcome!
6 months on the wagon train for the lion kingdom. Lately noticed the insertion point starts out painful but the pain goes away after running a mile. Wasn't sure if the neurons were shutting down or if mobilizing it was beneficial.
Is wearing compression sports socks counterproductive after what you said about compression.
They can sometimes be - observe how you feel after wearing them for a while. When mine was flared up it didn't like any pressure on it.
@@SportsInjuryPhysio thank you
Reading here to learn more, weighing in to say compression socks would help for really short periods of time when I know I was swelling. I would take them off often. Now that Im out of that acute phase I don't really see swelling but I don't bother anymore.
Wow, thank you such great advice, I have been having foot and ankle problems for some time and its has only been diagnosed as PTTD. Unfortunately I have to stand and walk for long periods of the day as I am a school teacher and walk/use public transport. I am going to use this advice to try be lazy where possible and sit down and work. And I will but a new pair of shoes tomorrow.
Best of luck!
This is really helping me
Stand with a small hot smooth rock under your arch for a few minutes. Definitely helps my arch and ankle relax. Developed my tendon troubles from a trip from a stumble and misstep in a hole while running through a field.
how long have you been dealing with your tendon troubles?
So, I've had this problem with my tendons in both feet for years but never knew what was going on until I started researching because I am currently in a boot for three weeks because I ended up with a bad case of tendinitis in my left foot. I say for years because I am a caretaker/homemaker and the long hours of standing in the kitchen would just tear me up on the bottom of my feet in the arch area but I didn't know why, the walking to do grocery shopping and such isn't too bad unless I was with others and ended up doing walking and stopping and waiting and walking, stopping, and waiting, etc. Then I would come home and my lower legs and feet would ache for days. Last Sept. I had a bad sprain and a small fracture on the outside of my ankle where the tendons attached and was in a boot for a couple months and felt great afterwards. I tried doing the band exercises but found them difficult on my own and finally stopped thinking my dance fitness classes were enough but apparently the weren't helping. Question: you say that shoes/insoles are important, if I am at home and needing to stand for an extended period of time should I be wearing shoes? I usually go barefoot. The other question is do you have a video or videos on the progression of exercises I should do so that I don't have this happen again in the future. Thanks.
How are you doing now
@@Ashish-nd3xj Found out I had two tears in my post tib and they did major surgery - basically 3 surgeries at one time. I'm now out of physical therapy and doing better. But I really wish I had known these things before.
@@grannysquareswagonwheels2604 so sorry to hear about your surgery. Glad to know you are recovering well. If I may ask at what age did you start to see the pain and how old are you now. I am just 39 and have had multiple ankle problems since last 4/5 years ! Use custom orthotics. Felt well for a few months but now the pain has come back ! Did your physio therapists and doctor say you would walk normal now ?
@@Ashish-nd3xj I don't really remember when it started but I was in my early 40's when I started working where I was on my feet all the time and then it kept getting progressively worse. I quit working outside the home and started watching my grandbabies and then it lessened because I wasn't on my feet all the time, not because I was exercising/treating them. Then the last 2 years I noticed it was just painful standing in the kitchen and so I was doing some general exercise but it exacerbated it instead of helping it. I wish I had gone to the doctor earlier and had him send me to physical therapy so I could have learned the proper exercises to help. I am nearly back to normal now but will continue foot and ankle exercises to prevent needing any surgery to my other foot. I am 54 now.
@@grannysquareswagonwheels2604 that's nice to hear that you have had a successful surgery and recovery. I am just too worried about this injury which started while running a few years ago. Yes, the physios talk about the ankle and other exercises but I don't know how much they help. Just like you, i didn't know for long what was happening. Just the last year a podiatrist diagnosed with this and asked for an orthotic. Do you use orthotics now ?
Typically, how many days or weeks should I be off my feet and be able to start some exercises for my foot?
Im battling w this issue, running a half marathon on Saturday and its frustrating not able to push, I also work standing in a cardiac cath lab where I stand wearing 20lb leads on😊
I knew my foot was damaged but had to walk for 2 more months and then I couldnt walk. HOW LONG do I have to stay off of it? I am 4 months in. Moon boot next and I don't know how long to stay off it. I have crutches but I walk all the time and move stuff all the time.
Thanks for the video. I will try these strategies. I have been dealing with this pain for several months. The pain jumps around from the sole of my foot, to the inside of my ankle, to the post tib tendon area near the ankle to my achilles tendon and even into my calf. What does it mean if the pain jumps around like that? Could it be an issue with nerve compression rather than actual damage in all of these areas? If rest the best approach for nerve compression? Thanks!!
It does sound more like a nerve injury (not compression necessarily). Rest is not always the best treatment - it depends on what is irritating the nerve. It may even be coming from your back. So, the best course of action is to get it assessed by a physiotherapist and get tailored advice. If you want help with your rehab and an exercise plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
I think it's important to wear some type of orthodic that is posted so that if overponation is part of the cause for P TTD it. Stops the ankle from everting. I am going through This myself and I'm having a very hard time dealing with it emotionally because I can no longer walk properly. In addition nobody talks about getting Internal tibial rotation as the ankle weakens and pronates even further. My altar sounded revealed I have damaged in my Posterior tendon and calcification. I also have functional Leg length discrepancy which could be part of the reason why I overponate more on the longer side. I How? Been going to physiotherapy and feel that none of the treatments are helping even though I have gone Three different physiotherapy places. I don't think they really know how to deal with this condition and are giving me the wrong exercises. My foot doctor actually said it is okay to walk on my ankle even though he knows there's damage to my tendon. I cannot believe he would give me such ill advice. My authorities dig into my feet so horribly and of course arthur wearing my body a little bit off balance I am so uncomfortable. I never expected to lose my mobility without being an accident. This is a horrible debilitating condition that I never knew about. I could go on about doctors and other medical professionals. Should Patients be braced so that their tendon can heal? If so what type of Brace is Required to give the tendon a break? And do these tendons really have the capacity to heal When they've been stretched from overprognation? It doesn't seem plausible to me. It seems that surgery is the only way to go. The wait list for an orthopedic surgeon in canada is over a year long.
@_Sports Injury Physio: could you please share brands of good shoe insert? I need one like you showed...Thank you
Im a runner, or used to be at this point. Been dealing with this for 8 months. Going crazy. Pain when standing now, just took a big step back. Hoping to find an answer soon.
Ugh - that is frustrating. If you want help with your rehab and an exercise plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
I see this is an old video. Do you all still offer consultations? I’m in the US, not sure if you consult with patients here.
Hi there,
We consult with many patients who are in the US.
I don't personally do consultations anymore, but you're welcome to book a video consultation with one of my colleagues. If it's tibialis posterior tendinopathy that's your issue, Kevin's your man (but they're all very experienced).
More info here: www.sports-injury-physio.com/
How do you feel about oral corticosteroids for this condition in a low dose? I have posterior tib tendinosis and a grade 1-2 strain in the distal/medial aspect of my soleus and gastroc. Thanks
Hello i have tib post tendonitis for too long what is cost of onlain help from you
Hello - you can see our prices and read more about the consultations and how it works on this page: www.sports-injury-physio.com/services
Great vid. I got ghost shoes which are probably too much for me. Will need harder shoes I guess
Can you recommend good shoes?
Shoes are a personal thing, so you have to try them before buying but usually Asics and New Balance make good shoes - ask for medium or strong support when you go to shop depending on your foot/ankle mechanics + bodyweight.
I wear Brooks Ariel. Foot is 100% flat, no arch. I also have Brooks Glycerine which is slightly less stiff
@sportsinjuryphysio No matter what Bob & Brad say you are the best PT on the internet. I just switched to trail running from many years of road running and developed this condition, occasionally my left leg/ankle just seems to lose all control and power for a second and I almost go down. It comes back to normal right away, is this a symptom of this condition or something else?
🙃Thanks - I think you need to get it checked because this is not a typical symptom or thing that my patients with Tib Post injuries report. A leg can sometimes give way like this when a joint is injured or when a nerve is not 100% happy.
What can someone do to strengthen the tendon?
I demonstrate some exercises in this video: ruclips.net/video/qcc7G3aTmCg/видео.html Check out the chapters to jump to the relevant sections.
An excellent video. Thank you so much Maryka..
Two short questions:
Can you please recommend some glut. exercises to help and secondly will the APS machine help this condition.?
Thank you so much.
Check out Bret Contreras for more than you ever wanted to know about glute training. My partner and I have both seen great results using his recommendations.
what are treatment options after you have had surgery for pttd? .I still have pain in my foot and tendons, pin in my heels and other stuff to give a small arch.
The main treatment would be a carefully graded strength training plan but other treatments like custom made orthotics to support your arch and tendon and PRP injections may also be useful - your doctor should also be able to advise on this.
Can I run Marathon with insoles. I do have pain but it's been months want to go back running. Please suggest
It is best to ask you physio - I can't tell what is safe for you to do without assessing you.
Excellent video. My injury is from March 10 and the inflammation is focused on the insertion of the scaphoid bone (it seems that it came out much more inward). I am resting a lot and with ice 3 times a day) Just on April 26 I do an MRI. Can cordoned neoprene anklets help me until I have an accurate diagnosis? Walking crookedly is causing pain in my spine. Thank you so much!!! My name is Adrian and I am from Argentina.
Hi Ive found this useful but my mri shows longitudinal rupture of post tib and the pain has been there for over a year
Tried physio n pain meds n arch
But nothing seems to work
Standing is an issue
Pls can you guide me 🙏🙏🙏
How are you feeling now?
Very useful video and knowledgeable presenter. Thank you. I had been considering different options for this long standing issue and your insight and thoughts has covered a lot of what I had wanted answers or information on.
Glad it was helpful!
Thoughts on PRP for PTTD? Specifically injected into the tendon sheath?
Hi there,
Here's our video about PRP: ruclips.net/video/XKCzp46oKNw/видео.html
Thank you so much for sharing your knowledge. I do get relief from dry needling but I feel like I need to strengthen because the pain comes back. Does the banded dorsiflexion exercises help where you pull the top of foot straight up towards hip? I’ve read a study that recommended that as one of the treatments, but don’t understand how this would help.Thanks again.
is icing ok ?
Yes. It feels much better and helps with swelling. They also suggest anti-inflammatories as well.
Hi, these videos have been upser helpful so thankyou! My podiatrist has been no help over the last 3 months. I get better then something happens and Im back to it being bad. I was doing relativley well last week with some rehab exercises but one day woke up in a lot of pain and a lump I think where the tendon attached to the foot and it stings. This seems to come and go depending on pain. Any idea what this may be and if its ok to try and hand / tennis ball massage out?
Hi there,
We cannot provide individual treatment advice without doing an in-depth assessment of your injury and your personal circumstances, as the advice might not be appropriate for you. You're welcome to book a video consultation with one of our physios if you would like an assessment and a personalised treatment plan: www.sports-injury-physio.com/
I've had this for six years now, and counting. It has really messed me up. Nothing works. Plus all the several physios I have seen always seem to fixate on my problem being insertional achilles. OK maybe I have that as well, but that's not where it *really* hurts. All the time. Complete rest (for months) doesn't help at all. Exercises can certainly make it worse. Walking can make it worse. Running ... just a little bit, not necessarily bad.
Hmmm, yes, if your main pain is not actually at the insertional Achilles but rather this, then this is where the treatment should be focused. If you want help with your rehab and a treatment plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
I started cramping in this area after a foot drop. What is that?
Foot drop is usually linked to damage to your nerve that supply the Tibialis Anterior muscle resulting in the muscle not being able to work. In addition to doing dorsiflexion (lifting your foot as you walk) the Tibialis Anterior is meant to work together with the Tibialis Posterior to support your foot arch and stop it from rolling in. If your Tib Ant is now not working, the Tib Post and other muscles in that area might be overworking and that can result in cramping. So, you might actually benefit from arch support (orthotic insoles) and some strengthening exercises for your foot in general but it obviously depends on the finer details of your specific situation.
Do you think that barefoot shoes such as Vivobarefoot shoes would help or hinder a Tib Post issue?
It really depends on your current injury state + the actual cause of your specific case (anatomical vs. just weak muscles vs. lax ligaments) + what activities you plan to do in them - they have very little support so if yours is currently injured they will likely just make it worse. But once fully recovered you could use them to strengthen (only if your foot shape is right - if flat feet then likely will continue to aggravate) but you will likely be at higher risk of reinjury if you do any activities that push your body into fatigue because at that point your muscles won't be able to provide as much support to your ankle and it will then also not get support from the shoe = more likely to cause trouble.
Very informative video. Please give me some advice regarding my situation. It took 6 months for the swelling of my inner ankle to go down due to post tib injury. Once the swelling was gone. I had noticed that my foot had taken on a different shape. My navicular bone is much more prominent now. I assume it's because the tendon is now healed into an elongated position and not putting enough tension to support the arch. I now struggle to walk with the collapsed state of my foot although pain is minimal. I do regret not having worn a moon boot, for I've put a lot of stress on the tendon with my lifestyle. But now I am afraid I have caused permanent damage and will not be able to walk or run normally again. Is it possible for the tendon to pull tighter on my navicular bone and lift it back to its normal position?
It is difficult to provide a definitive answer without actually assessing you but often the only way to know if it can improve is by working on it and seeing what happens - it takes months of exercise + correcting your foot posture during the day to see results (if possible). In my experience it usually requires a combination of:
1. Custom orthotics to help support the tendon and arch while you work on strength
2. Doing strengthening exercises - here are some ideas: ruclips.net/video/5ompYPEHbyM/видео.html
3. Making sure your wear supportive shoes
If you wanted help with your rehab and an exercise plan, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com/
Kills me stood in one place I have osteoarthritis in both feet flat foot both feet planta fachitis & spurs on both feet I tripped of 2nd stair at bottom of my stairs at home I've seen 3 phiso 2 padiatrist they think it !aybe paroneal tendanopathy ime now having a m.I.r. scan in July complete agony cannot walk at all the left foot has become bigger than other foot I cannot work like this I done this October 2020 its been 8 months CNT cope much longer when I sit for a while I go to get up & the foot won't move not even one step same when I get out of bed its like it sieves up they wnt give me pain killers as ime on tramadole for my osteoarthritis I have crutches I cannot walk up stairs where I cannot bend feet never been able to go up stairs 8 months I wish I cld walk I limp over to one side so much pain please help and advice.
What if stiff shoes hurt me more??
Hi! Found your video trying to get some information about post tibialis tendon issues. I started having pain in the plant of my foot and immediately though about plantar fasciitis. After a few days of stretching and exercises I noticed it didn’t get better and contrary to what happens with plantar fasciitis first steps in the morning were bad but it tend to get worse during the day when walking. Haven’t been running of course... went to have some personalized orthotics and the pain on the plantar fascia is almost gone but the area of the post tibialis tendon and navicular is somewhat tender to the touch and gets irritated with activity.
Would really appreciate any advice.
Thanks in advance!
How are you doing now
I’m wondering if my recent effort to practice heel-toe walking as aggravated my Post Tib tendon. Is this muscle involved in the windlass mechanism? I’ve been progressing slowly in minimalist shoes even forefoot walking for 3-4 months. But I experimented with some heel strike walking with greater foot flexion than I was getting from forefoot walking. The other variable is that I also experimented with a TENS unit. Not sure which to blame most.
It can irritate the tib post but I am wondering if you've not perhaps aggravated your Flexor Halucis Longus tendon that runs from the big toe and along the same line as the Tip Post. It is often overworked when people try and push off more pronounced with their big toes which I think may have been the case with practicing your walk pattern and because the tendon runs so close to the Tib Post is is often mistaken for Tib post tendinopathy but it is actually FHL.
I HAVE A BIG QUESTION FOR YOU THAT PEOPLE WILL PROBABLY LIKE TO KNOW. Mine is on inside of ankle been going on for 12 months now and on inside of ankle . with all the exercises I've been doing i have shoe insert in but i feel like my better leg is shorter than other and hip ache on better leg like its shorter than other is this normal. the side the ankle is bad has hurt my knee to not tracking under knee cap
I can't really answer you without assessing you and seeing what is actually going one. It sounds as if you can benefit from seeing a physio who can look at your whole body and check what may be affecting it.
I have this injury 5 weeks. Didn't even notice it at first so continued running on it. Now very weak, swollen and even bruising sometimes. Question - can I swim (pushing off walls?) and/or use a turbo trainer?
In my experience cycling often makes it more aggravated at the start. I would start with a swimming session where you don't push off the wall and then observe how you feel in 24 hours after. Then test one where you do push off the wall and observe how it reacts. That should give you the answer as to what yours is happy to do at this moment in time.
Twisted the ankle and tore the tendon 6 years ago. Hasn’t been the same since. Inner tendon is aggravated whenever I walk on uneven ground for even as little as one hour.
Laura, agreed. I didn't tare it but over use injury since 5 years. How are you managing it now
@@Ashish-nd3xj I found that constant stretching and strengthening of all muscles around the ankle has made a world of difference. If I’m inactive for even a couple of days everything tightens up. It takes a lot of work to keep the tendons stretched out and supple. Better than surgery though.
@@loralora4368 okay. Did you do MRI and that's how you got to know it is a tare ? Are you waring orthotics
@@Ashish-nd3xj No longer wearing orthotics. I did for a while until the muscles were strengthened. Yes, I had an MRI. The tear healed. I still have residual pain, however, if I don't continually stretch and strengthen the ankle.
That's a hopeful story for me. Really nice to hear. Please be careful with it and don't overdo. Keep waring orthotics if you can. How much time did it take you to recover (complete rest in boots/cast ?) from it at the time of initial tear. Sorry if I am bugging you
What if my ankle pain has completely gone away; it used to be my ankle area and the bottom of my feet; it’s been 2 years since I was diagnosed and I’ve done the exercises. Now the bottom of my foot is what hurts.
This video may help you identify your foot pain: ruclips.net/video/GcVgQO3pCtg/видео.html
I’ve been struggling with pttd in both feet since may of 2022. I have foot leveler orthotics and day braces on both feet. Dr currently has me on anti inflammatory medication day 3 and still sore. I work a pretty sedentary job/lifestyle so don’t understand why this is happening. Weekends I spend a lot of time cleaning and standing in the kitchen. I know I need to lose some weight which probably isn’t helping but kind of difficult when you can’t move. I also have si joint problems. Any advice you can offer would be much appreciated.
It may help to strengthen the muscles that support your feet. It can also help to generally become more active doing exercise like swimming, or exercise classes in the swimming pool or using a stationary bike. If you do introduce new exercise it has to be done slowly and gently with short sessions and enough days recovery between sessions.
If you do carry a few extra pounds, then losing those will also make a big difference as, besides the fact that it causes extra load on the tendons, being overweight also can lead to increased pain levels. But I realise this is not a short term solution as it can be hard to lose weight.
Has anyone tried the PRP for this? I had one but it came right back. I think I started my barbell training too quickly. I’ve dealt with this for a year and can’t do The recommend reconstruction surgery. I’ve tried off loading some but I think need to give that better focus
How are you doing now
Hello! I have an MRI diagnosis of insertional tip post tendinopathy. I have seen the MRI and it's the sheath of the tendon that is inflamed (not the whole tendon), where it inserts on the navicular bone. In fact, this was mistaken for a navicular stress fracture by two podiatrists (they thought they saw something on xray) and ended up in a moonboot for months until I insisted they order an MRI after literature consensus said navicular bone injuries must have MRIs.
In a podcast from Sean Docking tendon researcher in AUS, he said sheath tendinopathies (in general) are a friction issue, not a compression issue, but in your videos you say research say tib post it's a compression issue.
So my questions are: 1) do you treat insertional tib post tendinopathy the same way as in your videos, 2) any comments about an inflamed tendon sheath being a frictional issue? Thank you!
I have to be honest, I've not had anyone where they have been that specific with the diagnosis in that they've identified it to be just the sheath that is the issue. Friction and compression tend to go hand in hand. That part of the tendon naturally experiences compression and friction throughout walking, running etc. and it is only when this becomes excessive that it is a problem. I'm not sure how you would tell if it is friction more than compression that is the problem and I would argue that by addressing the compression component you will also tend to decrease the friction. I treat patients according to their symptoms and how their injury react when we try out different exercises as well as what their biomechanics look like. My treatment programmes are rarely the same for 2 people with tib post tendinopathy as no 2 people ever have the same circumstances, built and activity levels. Does this make sense?
@@SportsInjuryPhysio thank you for your thoughtful input! Makes sense. You have the most educational tib post videos.
Hi Shannon, is your tib post fine now.
@@Ashish-nd3xj Hi there, I am not 100% but my post tib and foot are highly functional meaning I can run, hike, ski, bike. But if I go over my current limit that I've trained for, yes I will start to become "aware of it." I haven't and an acute flare up in months thanks to proper rehab and managing my loads, the latter being very key. I still rehab my calf muscle as this is happening on my ACL reconstructed leg and calf muscles is critical overall.
@@1shanshan76how’s it now?
What did you do to rehabilitate? Thanks!
Not sure if anyone will ever see this comment but I was wondering if anyone has swelling with posterior tibial tendinitis? I have a running injury from a year ago, had an MRI after 5 months of not getting better. Was told anterior, posterior, and ankle tendinitis along with shin splints. I have a knot near the post tin muscle belly and swelling, especially after exposure to heat and or exercise. Tried therapy to no avail. Anyone have a similar experience?
I have similar swelling. What did you do to get rid of swelling?
Please be honest, are people suffering from PTTD better off just getting surgery? I feel like the excercises havent helped and i just wasted a few months
I've not had any patients who needed surgery. Sometimes the exercises can actually be the reason why it stays aggravated. So, if they are not helping I would stop doing them and see what happens if you just really take care of it and try to take the strain off your tendons by wearing sensible shoes and limiting time on feet. If you see it starts to calm down, continue that approach and then just super slowly increase time on feet again over time but always focusing on the best shoes and support you can give the tendons. Injections can also be useful add-ons for stubborn cases.
You video will help many people like me
It wont life post PTTD will never be the same this injury has ruined my life
And I think you e explained why everything I think injured my top foot did. Loose shoes, barefoot climb up an aluminum ladder with week foot muscles and leaning into my right toes and into left inner foot because of a stroke. Therapist said I don’t know where my shoulders are so it’s hard to be standing correctly.
I m facing this issue from 26 months tried every thing but not recovered at all ..
Can you please help me how to I get rid of this injury please
Hi Kunjal,
We cannot provide individual treatment advice without doing an in-depth assessment of your injury and your personal circumstances, as the advice might not be appropriate for you. You're welcome to book a video consultation with one of our physios if you would like an assessment and a personalised treatment plan: www.sports-injury-physio.com/
I’ve been having swelling for 7 months has anyone done anything for it
My PTTD started imroving rapidly when started wearing precription below knee compression stockings. It reduced the swelling a lot. Mind you I have been wearing these 24 hrs per day. But has been worth it. The pain improved a lot within 24 hrs of starting to wear these. This goes along with the PT on this site saying there is a "compression" component to the pain of PTTD .
RT
Shockwave sadly did not work (waisted 500 EUR). Has been two years now.
I though compression was good to help decrease swelling
Maybe, it's compression against the bone, where bad rubbing happens, that we're trying to avoid with tib post x ankle bone. At least, that's my understanding.
A doctor said: your face is really red. He sent me to an oncologist who told me you have polycythemia. Have you been skiing or chasing your dog? A sign of polycythemia is an abnormally high red blood cell count.
Is there any hope? All I want to do is walk...life feels so dark. I just want to be healthy again. I didn't know what I had
Of course there's hope! Get help from a physiotherapist - they can help you understand how to overcome this.
If you want help with your rehab, this is something that our team of physios can assess and help you with via video call. You can read more about how the online consultations work here: www.sports-injury-physio.com
Plz help
This is just nonsense...most people stand on their feet for over 12 hrs a day for work...then we go and run for 2 hrs everyday! And workout for 2hrs a day. Sitting is just not an option in real life!
Absolutely ! After spending 7 months in it last year, it has come back now again !!
I have had three ankle injuries since October 2019, the last one being this august 2021. I am still having pain while standing due to tib post tendinopathy. Would you recommend I try to stop doing the inversion/eversion exercises over going into an aircast for 3 weeks? I have started in an aircast since Thursday (4 days ago)? @sportsinjuryphysio