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Top 5 Running Injuries: Achilles and Posterior Tibialis Pain

With the budding of spring weather and limited workout options, many are turning to running as their primary form of exercise and to maintain mental sanity. The New York Times has even deemed this “social distancing” and pandemic era as a “Back to basics exercise boom”. Even with no races in sight, there is no substitute for how a good run feels after a long day of virtual meetings, reorganizing life as we know it, and keeping the kids on track with school. 

This is the second installment in our blog series explaining the causes, prevention, and treatment of the top 5 running-related injuries we see in the clinic. If you missed the first one on the basic principles of overuse injuries, check it out here

So, without further ado, let’s dive right in and review Achilles and Posterior Tibialis tendon pain! 

Relevant anatomy

The two tendons that we are going to reference here are the Achilles and Posterior Tibialis tendon. 

The Achilles tendon is located on the back of the ankle near the heel. It is where the two calf muscles- the gastrocnemius and soleus- meet and form a common insertion. These muscles are responsible for both forward propulsion and control of the lower leg while running. 

The Posterior Tibialis muscle is a deep muscle that originates near the back of the knee and follows the shin bone down the leg and toward the instep of your ankle. It becomes more tendinous as it wraps around the inside ankle bone and attaches near the arch of the foot. It functions to control pronation, or inward collapse of the foot with walking and running. 

While searching for online advice for tendon injuries, you may come across several different names for this condition: tendinitis, tendinosis, or tendinopathy. These labels refer to the chronicity of the problem. Tendinitis is used to describe a more acute and short duration problem, while tendinosis and tendinopathy indicate long term tendon injury. Studies on injured tendons often reveal the absence of inflammatory molecules, suggesting that while an athlete may perceive sudden onset of tendon pain, the underlying microtrauma has been accumulating over time prior to reaching the symptomatic threshold

Symptoms: What does it feel like? 

Achilles: Runners with Achilles tendon pain will experience localized tenderness or pain directly over or near the tendon on the back of the heel. The area may be swollen or red, and there is potential for visible swelling or a “bump” located on the tendon. The tendon will oftentimes feel stiff, particularly in the morning or after sitting for prolonged periods of time. Depending on the stage of the injury, the tendon can “warm up” in the first few miles of a run and actually feel fairly good during activity, but then the stiffness or discomfort persists once the body cools back down. There also may be discomfort while running uphill vs. downhill. These are warning signs, and should not be ignored! 

Posterior Tibialis: Runners with Posterior Tibilais tendon pain can experience pain and tenderness over the inside of the ankle and/or the inside of the foot and arch. Swelling can occur in this region, however it is less common with this injury. Because this muscle is very closely related to the tibia (shin bone) and the tibial nerve (a branch of the sciatic nerve), be on the lookout for tenderness along the inside of your shin or numbness, tingling, or burning/shooting pain into your foot, as these are symptoms of something else going on. 

Causes: Why do these injuries happen?

The reason we are grouping these injuries together is because they are closely related and the underlying issues that cause them are very similar. These factors include, but are not limited to: 

  • Limited ankle mobility

  • Inadequate control of foot pronation with walking/running

  • Overuse: too much, too soon

  • Hip weakness

  • Intrinsic foot muscle weakness

  • Running gait abnormalities/asymmetries

  • Rapid change in terrain of running 

  • Inappropriate footwear 

Treatment: How do I fix it? 

A key component of rehabilitation programs for tendon injuries is appropriate loading of the area, with eccentric and heavy load of the tendon bolstered by current research. These exercises are important because they stimulate remodeling of the tendon, helping to improve its resilience and return to pre-injury health. 

Temporary cessation or a reduction in activity may be necessary to jump start the healing process. This period will be different for everyone, varying by age, duration of symptoms, severity of injury, and injury history. Pay attention to your symptoms and adjust accordingly if they seem to be getting worse. To manage muscle soreness and tightness at home, utilize a foam roller or Tennis/Lacrosse ball to work out trigger points, focusing on the calves and muscles adjacent to the shin.

Additionally, improving ankle mobility (particularly dorsiflexion), balance, foot strength and control of pronation, and hip strength will help in decreasing strain on both the Achilles and Posterior Tibialis tendons. This not only will help you recover faster, but also prevent this issue in the future! 

Getting in to see a PT or other healthcare provider is difficult during this global pandemic, so we at Precision have got you covered! We’re offering Telehealth sessions to help diagnose, manage, and teach proper exercise form. We also have DIY programs specific to Achilles and Posterior Tibialis injuries, located in our online store. These include exercise videos, appropriate progression of exercise to address the aforementioned risk factors, and other tips and tricks to get you back running healthy!

Stay positive, healthy, and well,

Kacy Seynders, PT, DPT


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