Have you ever had pain in your foot while running? Does this pain get worse as you run until you eventually have to stop? Well then, you may have an injury of your tibialis posterior. Foot pain in runners is very rarely down to being not flexible enough, or not foam rolling enough, or not having the most expensive shoes that the salesperson tries to convince you that you ‘need’. Running is a very challenging thing for the body to handle, and when we ask the body to absorb more force than it is capable of, pain is the best signal that the body knows to tell you to either do less, or get stronger.

What is the Tibialis Posterior?

The tibialis posterior is an important muscle in your lower leg. The main portion (muscle belly) of this muscle is deep in your calf, actually under your soleus and gastrocnemius muscles. However, it has a long tendon that goes down the inside of your ankle and attaches to your navicular, medial cuneiform, and three of your metatarsals. The main job of the tibialis posterior muscle is to support the inside arch of your foot while walking and running. Injuries to this muscle are most commonly at the tendon, either along the inside of the ankle or at its attachment to the navicular bone. Injuries can range form mild irritation, all the way to tears requiring injections or surgery. When injured, the most painful activities are usually:

• Walking for longer distances

• Running

• Jumping and landing in sports

‘’I should rest my foot right?’’

In some cases, the injury is severe enough that rest is required. For some patients, this may involve either reducing mileage or completely stopping their running. In more severe cases, the patient may require an orthotic from a podiatrist to offload the tendon, or even a boot to wear to completely offload that part of the foot. In more moderate cases, ‘relative rest’ is appropriate whereby we reduce mileage and begin a rehab plan to get the patient back to their 100%. Overloading an already injured tendon may cause a worsening of the injury, which will lengthen the amount of time it will take to treat the issue.

Rehab Options 

If you are suffering from tibialis posterior pain, then you need to think of your treatment plan as a multifaceted plan.

Gait Analysis:

On a treadmill in clinic, we can observe if there are any parameters around your gait that may be contributing to the injury. We can see whether foot strike, cadence, or speeds can be modified to get you running while respecting that we have to give the tibialis posterior a break.

Strengthening:

Initial treatment will always include some specific strengthening of the tibialis posterior, but we would always target the larger muscles in your leg. In clinic, we would test for muscle imbalances using digital dynamometry for accurate results. Here we can ascertain if there are muscle groups not pulling their weight (note the painful side isn’t always the weaker side).

Pain Management:

Depending on the extent of the injury, we may either need to manage pain with offloading tape, orthotics, or a boot. Although tape isn’t a long term solution, it can be very useful in the first few weeks of rehab.

Managing mileage:

In mild cases, an immediate change that will be beneficial would be to reduce your weekly mileage. This may also include modifying the type of running you do, wheter we swap the roads for a treadmill or a park, and whether we add intervals to your miles to get the appropriate amount of miles into your program.

If you have any questions on whether physio is the best option for you, or you have any questions about MVMNT in general, feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.