Posterior Tibial Tendonitis (PTT) is an overuse injury often encountered by runners and active individuals who place repetitive, high-impact stress on their lower limbs. This condition involves the irritation or degeneration of a major tendon responsible for maintaining the foot’s structure, causing pain and functional changes along the inner ankle. When faced with this diagnosis, the immediate question for an active person is whether they can continue their running routine. The answer must be clear and direct, as ignoring the pain carries a serious risk of long-term damage to the foot’s biomechanical integrity.
Why Running Is Contraindicated
Continuing to run with posterior tibial tendonitis is strongly discouraged because the high-impact, repetitive motion significantly increases the load on an already compromised tendon. Each foot strike places a substantial strain on the tendon, which actively stabilizes the foot and prevents the arch from collapsing. Repetitive strain in this acute phase will exacerbate the existing irritation and accelerate the degenerative process within the tendon tissue.
Ignoring the initial pain risks the condition progressing from a manageable tendinitis (Stage I) to a chronic dysfunction. This progression leads to a gradual stretching and weakening of the tendon, eventually causing the inability to support the medial arch of the foot. The failure of this dynamic support structure results in the development of a progressive collapsing foot deformity, commonly known as acquired flatfoot deformity (Stage II PTT).
Once the arch begins to flatten due to tendon failure, the structural damage can become permanent, potentially requiring complex surgical reconstruction to correct the foot’s alignment. Pushing through the pain increases the likelihood of a complete or partial tendon rupture, which represents the end-stage failure of the support system. Stopping high-impact activity immediately is not merely about managing discomfort but about preventing a cascade of structural changes that severely impact mobility and quality of life.
Understanding Posterior Tibial Tendonitis
The posterior tibial tendon originates deep in the calf, courses down the leg, and wraps behind the prominent bony bump on the inside of the ankle (medial malleolus). It inserts into several bones on the underside of the foot, primarily the navicular bone at the apex of the arch. This path makes the tendon the primary dynamic stabilizer of the medial longitudinal arch. When the foot strikes the ground, the tendon works powerfully to invert the foot and prevent excessive pronation, holding the arch up against impact forces.
Tendinitis arises when the tendon is overloaded beyond its capacity, often due to a sudden increase in running mileage, poor foot biomechanics, or unsupportive footwear. This overwhelming stress leads to micro-tears and degeneration of the collagen fibers within the tendon.
Symptoms include pain and tenderness along the inner ankle and arch, worsening with activity like walking or standing on the toes. As the condition advances, patients often experience difficulty performing a single-leg heel raise, which tests the tendon’s strength. Swelling is common along the tendon’s path, and a subtle flattening of the arch may occur, signaling the loss of the tendon’s stabilizing role.
Immediate Home Care and Safe Movement
Initial management requires immediate adherence to the R.I.C.E. protocol to decrease localized inflammation and protect the tendon from further mechanical stress. Rest involves the complete cessation of all high-impact activities, allowing the irritated tendon tissue to begin healing without repetitive strain. Ice should be applied to the painful area behind the medial malleolus for 15 to 20 minutes several times daily to reduce pain and swelling.
A compression bandage or elastic wrap helps manage swelling and provides mild support. Elevation of the foot above the heart assists in draining excess fluid from the injured area. Nonsteroidal anti-inflammatory drugs (NSAIDs), if medically appropriate, can be used short-term to manage pain and reduce the inflammatory response.
Cardiovascular fitness must be maintained through safe, non-weight-bearing activities, as rest from running is non-negotiable. Low-impact cross-training alternatives like swimming (using a flutter kick) or cycling on a stationary bike are generally tolerated well. Any activity that causes tenderness or discomfort must be stopped immediately to avoid re-aggravating the healing tendon.
Professional Treatment and Resuming Activity
A professional assessment from a physical therapist or foot and ankle specialist is necessary to properly stage the injury and develop a structured rehabilitation plan. Non-operative management is standard for early-stage PTT and includes physical therapy focused on gradually strengthening the posterior tibialis muscle and supporting hip and foot muscles. This structured strengthening is crucial because the tendon’s capacity to handle load must be systematically restored before returning to running.
Supportive devices are frequently prescribed to offload the tendon and maintain the foot’s arch position. While over-the-counter arch supports may suffice for mild cases, custom-molded orthotics or an ankle brace are often necessary to provide the precise control required to prevent excessive pronation. These devices create a mechanically advantageous position for the tendon to heal while correcting underlying biomechanical faults.
Medical interventions may involve corticosteroid injections for severe inflammation, though injections directly into the tendon are generally avoided due to rupture risk. If non-operative treatments fail or if the condition progresses to a rigid, late-stage deformity, surgical options, such as tendon transfer or fusion procedures, may be considered.
Returning to running requires a criterion-based progression, meaning it should only begin once the individual can walk pain-free and demonstrate specific strength benchmarks, such as performing single-leg heel raises without pain. The return protocol must be slow and gradual, commonly following the 10% rule, where running volume is increased by no more than ten percent per week. Any recurrence of pain exceeding mild soreness signals the need to immediately halt progression and consult with the treating clinician.