Posterior Tibial Tendonitis etc

mykroberts

Barefooters
Mar 31, 2011
82
4
8
I just took almost two weeks off from running (5/16-5/27) to try and let an assortment of nagging pains and injuries heal, and after my run today my body feels the worst it has since I started barefoot running. The posterior tibial tendonitis (disclaimer - self diagnosed) is the only injury I think I know what's going on. I will also include what I have learned about a couple other symptoms just for my own record (and on the off chance they are related).



So a couple months ago I started my pre-run warmup walk and felt fine, but on my first step of the run I noticed that the inside of my right arch was sore. The soreness almost entirely dissipated by the time I picked up pace after the first couple of miles. I love to stretch and wiggle my feet after runs, and I experienced an imediate sharp pain when I tried to flex my right big toe down. After some quick googling I learned that the posterior tibial tendon helps support the arch and flexes the big toe down. When searching for a possible cause I saw that accessory navicular bones can interfere with the attachment of the tendon. I wish I had kept the xrays, but I went to a podiatrist when I was in high school who told me I had "gorrilla feet." Don't think that is a medical term but I had what I think he called bone growths on the top and sides of both feet (its from my mom's genes). I had extreme discomfort whenever shoes put pressure on the inside of my foot (can't rollerblade or ice skate much for this reason). I got custom hard orthotics that among other things were supposed to relieve this pressure (and reduce pronation?). I never much liked the things as it raised the height of my foot, and the other bone growth on top would experience excessive pressure/discomfort even with loose lacing.



So if my self-diagnosis is correct is there anything to do other than surgery? Is surgery even effective for this? I took two weeks off (with contrast hydrotherapy for my feet) and it feels as bad as it ever has and my left foot might be starting the beginning stages as well.



OO5FW.jpg


With both feet relaxed my right toe seems to curl up slightly more than the left, and the arches look a tiny bit different (or I am just seeing things).

RMvu7.jpg


Angling the foot to show where the extra bone sticks out (furthest spot to the left). It isn't that large but it is very easy to feel.

foot_accessory_navicular_causes01.jpg


What I think is going on here



Right Hip Pain (back/side region) - probably a terrible idea but I kind of want to really run hard for a week or two so I can identify or accurately describe the pain in the hip I am feeling. I had hip ITBS issues in 2000 but I can't really say the discomfort feels the same yet - back then it felt almost like a clicking sensation. I think I need to work on my core muscles - I might be running too much with my ass/hips hanging back as opposed to under my body. I noticed I do not experience the hip discomfort if I clench my glutes while running to keep them under me (could be that flexing the glutes just reduces the movement of the hips overall?).



So I went to a chiropractor because after a visual examination he told me my hips werent aligned (I also learned about tons of alignment issues in high school PT but unfortunately didn't keep good records). He changed his mind after the xrays though so I am not really sure I trust this guy. He also told me I am flat footed which I don't really believe. Anyway he did some testing where I had to use my leg muscles to oppose his pushing, once was straight up and the other I angled my foot in and pushed my leg out and up. For both my right leg was extremly weak (assuming he was using the same force). He claims that bad curvature in my lower spine was causing bad signals to my right quad/hip flexor. He did some quick chiro adjustments and repeated the test (with apparently the same strength) and my right leg was better. He then hit the bottom of my right heel and repeated the test, and my right leg was poor again. He claimed my right heel wasn't absorbing shock probably and was somehow interfering with the performance of the whole leg. He grabbed on my foot and gave my leg a tug which was supposed to help. I don't really have any knowledge in this area to tell whether he was full of crap or not...



Anyway, assuming my right hip flexor/quad are weak what type of injury could that cause the hip to be sore/injured in the back/side?





Sp71P.jpg


Could bad curvature in my back be weakening my right leg? Could this contribute to my hip pain?
 
Mykroberts,What I can tell

Mykroberts,

What I can tell from the photo is that your great toe deviates into a hallux valgus position which affects your base of support. this affects everything in your kinetic chain as you try to balance and stabilize in stance. se this link from our website

http://trtreads.org/Chapter_6.html

from the post it is hard to identify a specific structure for the pain and often that is not the most important part of getting well...it is understanding the function and your individual joint stability and mobility issues that affect your gait.

More important is to try to understand “why”. This often takes a really skilled PT, Chiro, or Athletic Trainer with specific training in running related issues.

Also sounds like you are not symmetric. Also you should not be clenching glutes to run. Glutes have some function in inner core and hip stability but as soon as your foot hits the ground you quickly release and allow hip to extend back.

surgery is rarely needed for what you are describing.

Wish i could give more assistance but can only give some general guidelines on email, you need a dynamic evaluation with appropriate corrections.





All the Best,



Dr. Mark
 
Thanks for the feedback - I

Thanks for the feedback - I understand you are pretty limited without me being there in person. I checked out the link and my big toe is probably misalgined - I guess that could contribute to less support for the arch and increased stress on the PTT? I also run with my feet angled out slightly which might be a problem.



I don't run with clenched glutes, was just trying to experiment a little to try and locate the pain or source. After a little more running I think the position is likely consistent with ITBS.



Anyone know an amazing running PT in West LA?
 
If you find one, please let

If you find one, please let me know, so I can add their info to our Barefoot-Friendly Map of Doctors and Specialists. Good luck!
 

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