Saturday, January 18, 2020

Posterior Tibialis Tendonitis

In 18+ years of running, I certainly have made the rounds of all the different types of tendonitis!

Patellar Tendonitis: Spring of 2008
Peroneal Tendonitis: Fall of 2009
High Hamstring Tendonitis: Summer 2013
Achilles Tendinitis: Fall of 2017

I can now add to the list Posterior Tibialis Tendonitis. Here's how it happened.

December 8: CIM
Before CIM. No tendonitis!
Upon completion of the marathon I noticed a pain in my arch. It hurt as I walked back to the hotel, and when I took the Vaporfly Next% off of my foot- OUCH. It was a burning pain of about 6 out of 10 on the pain scale. It seemed as if the shoe had been rubbing against my foot in a certain way to cause this arch pain. It bothered me for the rest of the day and and into the following day.

December 9 - 15: Marathon recovery
The pain went away completely two days post marathon. So much so that I forgot about it.

December 16 - 20: Easing back into running
I resumed running with short, easy runs of 30-50 minutes. I didn't have any pain in my foot.

December 21: First post-marathon symptoms
I did an 11-mile long run and the arch of my foot started to hurt about halfway through. It was maybe about a 2 on the pain scale, so I wasn't concerned. As I walked around on it for the rest of the day, I noticed that it felt off, kind of like a tight muscle.

December 22 - January 9: Blissful Ignorance (or denial)
I continued to train, doing hard workouts on the track and long runs of 10-13 miles. I even ran a 5K on New Year's Day without any problems. My foot would bother me a little, but it was more of an annoyance than anything else, never getting above a 2 on the pain scale.

After my long run on January 4th, my foot hurt more than normal, which caused concern. It was mostly okay during the run, but afterwards it was about a 3.5 to 4 on the pain scale for the rest of the day. Very tender to the touch and I could feel it with each step. That's when I realized I would probably have to address it. I continued with my training plan and track workouts until I could get in to see my physical therapist on January 9.

It didn't take long for my PT to diagnose me with posterior tibialis tendonitis; I had classic symptoms. The two areas of pain were on the bottom of my foot, where the tendon connected, and on the side of the foot, about one inch forward from the ankle bone, and one inch below. He told me I would need to take some time off running to let it heal. Not the news I wanted.

Area of pain - feels like a sore ache
This issue wasn't caused by "overuse"-- it was caused by my shoe rubbing the wrong way during the race. So how does that result in tendonitis?!  My PT had a theory that it could have been because the shoe had an 8mm drop (as opposed to the 10mm I normally wear) and it was extra bouncy, causing my foot to pronate, where it normally does not pronate. Or, it could have been rubbing against my arch the wrong way, which irritated the tendon, and now it's going to take a while to calm down.

So. . . couldn't I just train through it like I trained through Achilles tendonitis? He said that this was different and I needed to ease up to give it time to heal. Of course, in addition to doing exercises. He was concerned that I took a week off post marathon and it came back. And he said that this is a nagging injury and tends to come back unless you treat it with the exercises over several months.

January 10 - 13: No running; pool workouts only
I took four full days off of running, but I went to the pool every day. I mainly did deep water running with a floatation belt, but I also added in some swimming to save myself from boredom. And I simply enjoy swimming. I would do it all the time if it were more convenient.

January 14 - now
After my four days off, I started running again, but only 3-4 miles per day. And that's where I am at now-- I just finished a 3.5 mile run in the snow. And of course, I have been religious about my exercises. Rest alone won't heal this; I need to load the tendon with weight.

I'm now at a point where I don't feel any symptoms while walking around during the day, which is a big improvement. However, after about two miles of running, I do start to feel some soreness on the bottom of my foot. Since I'm only running 3-4 mile easy runs, this pain has been about a 1.5 to 2 on the pain scale, and I am back to being symptom free five minutes after stopping.

I also bought a pair of the Mizuno Wave Inspire-- a shoe I stopped wearing over a year ago when I was told I was a neutral runner. I am a neutral runner, but the added stability will reduce the load on the tendon as I recover and the firmness of the shoe will help too. My PT told me that cushiony, bouncy shoes were bad for this injury.

Looking ahead
I'm trying not to look ahead and take this one day at a time. I have no idea how bad this is going to be. Once I start increasing my mileage (next week) will the pain come back while walking around during the day? Will it become more painful so that I can't run? My PT said that I can let it get to a "3" on the pain scale. But anything above that and I need to stop running and go back to a reduced load. Thankfully, I haven't felt a 3 or above since the day of my long run two weekends ago, and I want to keep it that way.

If this had happened a month out from Boston, I probably would have continued to train through it at full intensity and waited until after the race to rehab it. But since Boston is still over 12 weeks away, I feel like I can get away with easing up on the mileage now and still run a strong race.

How I feel
Of course, this sucks. I'm generally optimistic because as I said above, it wasn't like I was overtraining or anything. It was caused by the Vaporfly during a marathon, so once it calms down it shouldn't come back. I'd be discouraged if my normal running routine caused this.

I basically have some loathing of CIM, though. I tried to be positive about my experience there, but now I just look back on that race with regret. I had a perfect training cycle and I was in the best shape of my life. I went into that race healthy and with no issues. I ended up having a difficult race, missing my goal time, not getting a PR, and ending up with an injury.

My primary positive takeaway from that race was that I had such a great training cycle and it would set me up well for my Boston cycle. But now just the opposite is true. The race set me up to start my training cycle off with an injury. If CIM had been the race I had hoped to run, I wouldn't be as peeved about this. I would have been "worth it." I'm glad CIM is behind me, and I'm never going back there and I'm on the fence about ever putting my foot in a Vaporfly Next% ever again.

Phew! Glad to get that off my chest. I am sour, but I have been distracting myself with my pool workouts and focusing on the healing process. So generally, I am in a good spot mentally. I still think I will be able to run well in Boston, and at least participate (if not run fast) in the races I have signed up for this spring.


  1. I'm sorry about your injury, it just sucks. Do you think it was just something about that specific pair of shoes or the Next% in general?

    1. I would LOVE to believe it was just that pair. I ran two half marathons and a marathon-pace 16 miler in them with no issues whatsoever. But the two half marathons were a different shoe (smaller size). I want to go back to using them, but I will have to wean myself into them gradually once this tendonitis is 100% behind me. Probably not until the fall race season.

  2. I’m so sorry about your injury. I hope it heals quickly. I’m also sorry that CIM was a bad experience. I have a special feeling for CIM as it was my first marathon in 2009 and possibly my last marathon in 2015. I’ve taken a lot from your injury posts. When you had your Achilles issue I was having something similar, and I took some tips from the exercises you did to heal. I’m also struggling a little with high hamstring tendinopathy, and I just went back to look at that post. I’ve always enjoyed reading about your races and experiences, and I hope you’re back pain-free running very soon!

    1. So many people love CIM, which is why I went there. But a race three time zones away never appealed to me, particularly one that could be warm. At least I can cross that off my list and cross California off of my states list! I'm happy to hear that my Achilles post helped you. I hope that high hamstring tendonitis clears up for you.

  3. Well drat was hoping you get into a great training swing for upcoming Boston next April. Where you show the concentrated area of pain or soreness, I always associated with plantar fasciatis! If you have PT issue or PTT don't you incur pain and issues at ankle and posterior side towards heel? Keep your optimism. A runner of your capabilities and trains and can run maximal capacity in marathon and other lessor distance races is bound to incur some injury issues. Usually it connected to some imbalance issue in gait and such, seasoned with insufficient recovery in later stages. But differences in shoes could be the factor and oh-so important to know your feet well and what type shoe works best. Vaporfly may be great shoes to race in...maybe keep them for the 5 or 10 ks, but when come to real half and full marathon...make sure you got the right fit and cushioning. Keep us posted how therapy goes!

    1. That picture of the foot isn't entirely accurate. The pain is on the side of my foot, so it's too high and too far forward for PF. I don't think the Vaporflys offer an advantage in the 5K and 10K distance, but I will probably return to them in the fall if this injury is 100% behind me.

  4. I guess the Vaporfly's aren't for everyone if in fact that shoe was the cause of the injury but I guess we'll never know (given it sounds like you won't be wearing them anymore, can't blame you if that's what you choose.) I like what Frogger has to say too, maybe keep it to shorter races (I don't know about everyone else, but I LOVE the feel of them on my feet.)

    I know you'll get past this and I'll keep you posted on my own struggles to try and get back from this peroneal tendinopathy (given it's been almost 4 months it's worse than tendonitis.) Your fans are pulling for you :)!!

  5. I'm so sorry to read you're injured. Hope the pain stays below a 3 as you increase your distance

  6. Inside of foot or outside of foot? Just came off a stress fracture and am tracking it to potentially my Nike Odyssey React, though I was wearing Vaporfly Next % when it happened. It was not overtraining either. May have additional questions too. Thanks and sorry for your injury. Heal up quickly.

    1. Inside of foot, in the arch area. I love my Odyssey react and have worn them injury free since they came out in 2018. I was also wearing the Vaporfly Next when mine happened. The Odyssey React has some light stability but the Vaporfly Next does not so that could be part of the problem.

    2. I have loved my Odyssey Reacts too. However, when V2 came out they were significantly more narrow than the original version. I believe I should have sized up a half size. This caused the rubbing, which I am theorizing may have led to the injury. That is why I had questions about your injury and similarities. As a side note, I saw an orthopedic foot specialist doctor, and am seeing a PT next week. Plus I was already fitted for custom orthotics. Just wanted you to know I am not ignoring your IG advice about seeing the proper people for an injury.

    3. I agree that the V2 was smaller. I ordered a half size larger than my V1 size, but that felt too big, so then I went back to my V1 size. It was just a snugger fit. I don't think I will need to go the custom orthotics route; I believe using the Mizuno Wave Inspire (firm stability) will help this heal and once it does, I am back to my standard rotation of Brooks Ghost, Wave Rider, Odyssey React, Adidas Adios.

  7. You know, my posterior tib tendon is STILL sore from the tear earlier this fall. I did fall off the wagon with rehab, though! So maybe my fault? I have also had several tendon injuries and the tricky part is loading them JUST enough. Too much rest just makes it worse - but you also don't want to overuse it!