This post about posterior tibial tendonitis has been over five years in the making. Whenever the pain subsided for a couple months, I thought about publishing, but then the tendonitis would flare and I didn’t want to finish this until it was fully in the rearview mirror. Now I realize it may never be completely in the rearview mirror but seeing as I’ve had my longest duration without soreness and I haven’t posted since the spring, it’s time.
I believe the athletic activity that precipitated the posterior tibial tendonitis (that’s the tendon that goes down the inside of the lower leg and inserts on the navicular bone) started during COVID “lockdown” when we did a 22 mile road portage pulling our canoe between the Whiteface and Saint Louis Rivers in Minnesota. On that long portage the road was often off-camber and for some of it I was slightly twisted from pulling the canoe. And 22 miles is a long way to walk in a day!
Initially the pain was localized to the navicular bone. I thought perhaps it was some plantar fasciitis and while I decreased my running frequency and mileage, I kept running through the pain. Then I thought it might be a stress fracture, but alas, it would often get better with running after a mile or so which made a stress fracture less likely. Over the summer and fall I kept running, even though running clearly exacerbated the pain. By now I was thinking it was tendonitis. I got an xray that was normal and saw Podiatry who didn’t have much to offer other than orthotics.
Occasionally, for a week or two, my tendon stopped hurting or got much better. But soon I’d feel it “pop” when I took my first few steps in the morning. It didn’t pop out loud, but rather it felt like the tendon was rolling around in my ankle. This was a sign to me that it was starting to flare and I should back off.
In the fall of 2020, after doing a longer run than usual, the pain flared more acutely and I took two weeks off running. This helped some but the pain returned when I resumed running and I stubbornly kept going.
 |
| Running with Craig and Nate at this year's (2025) Vakava Fall Camp. |
In the summer of 2021 I had a couple pain free months and thought maybe it was gone but then it came back. I still managed to run a half marathon, most of my runs having some degree of pain around the navicular, pain that sometimes even persisted when I walked. I kept this trend up, running despite the pain, until late 2022 when I did a couple longer runs including some L3 work (faster running always made it worse) and then the pain creeped up the inside of my leg, becoming suddenly sharp and essentially intolerable for running.
Finally, late 2022, 2.5 years after the pain first started, I knew I had to take a serious break. Not only did I stop running, but I also went down the stairs carefully to not strain the tendon and stopped all unnecessary walking because my lower leg hurt with every step I took.
Fortunately it was just about ski season, but even then, I was careful with my striding and herring-boning and did a couple weeks of just double poling. As the pain decreased, I slowly brought in walking down the stairs normally and then walking and striding.
Only when I walked around work and realized that I was mostly pain-free did it dawn on me how much I had lived with this pain and how incredibly stubborn and stupid I had been all those years.
 |
| Running in Trier, France this October (2025). |
In the Spring of 2023 after most of the pain resolved (I would still get some spikes depending on classic skiing, particularly herring-bone running), I started physical therapy. It was another couple months before I gradually eased into running but during that time I did some serious walking, usually for an hour at a time - substituting my usual running for walking. I enjoyed it more than I thought I would, taking life at a slower pace, admiring blooming tulips and daffodils.
By the end of April, after 6 months away, I began running again: 3 x 2 minutes easy with one minute of walking in between and so on and so forth. Strictly every other day only per my physical therapist. I was up to 3 x 8 minutes when Erik and I did the Chippewa Triathlon as a relay with my brother. The Chippewa Triathlon is an approximately 14 mile canoe, 27 mile mountain bike, and 6 mile run. My bro is a relatively fast biker and so we put him on the bike while Erik and I canoed. There’s a bunch of portages, equaling about 1.5 miles, on the canoe leg and typically we try to run those so right there I knew I’d be stressing my tendon. Erik was going to do the run leg but he’d been dealing with some of his own injuries. My bro wasn’t really in running shape either and not as advantageous to do so after the bike. Eventually we settled on dividing the running leg into three gimpy runners with Erik, then me, and finally my bro each running about two miles.
The thing about that two miles of running was I knew it was going to be really fast, at least for me, and much faster than I’d run in a long time and fast running always tweaked the tendon. It was fast for me, averaging 8:14 pace on single track trails, some of which were very rooty and had some tripping hazards. That night my tendon sure was sore but I massaged it and the next day it felt a lot better. I took a day off from running then did 3 x 8 minutes again, followed by two days off, and then a single session of 24 minutes.
By July I was up to 33 minutes of running and added in my first intervals with 9 minutes total at L3; granted, not really a long enough time to make L3 count but the point was to gradually ease in my leg to faster running.
My physical therapist gave me strengthening and balance drills and I did these diligently at least three times per week and have kept doing them, albeit not always quite three days per week, but at least two unless on vacation.
 |
| Finally running pain free, here in the vineyards of Alsace, October 2025. |
I was still really cautious in July of 2023 when Vakava teammate Ben hosted his annual Backyard Ultra. By now I’d done an hour run, covering 6 miles. I knew pushing the distance a lot was risky but still wanted to do something above what I’d been doing. I did a cautious three laps for 12 miles but only allowed myself to run for 2.5 miles of each lap and then did a fast walk for 1.5 miles of each 4 mile lap, arriving back to Ben’s house just in time to take a quick drink and head back out on course.
A week after Ben’s Backyard Ultra, I was finally able to resume my running to and from work routine. The shortest distance is 5 miles but I was able to run the long way home, totaling 7.25 miles. I continued running pain-free for the remainder of 2023, kept adding in speed, but my longest continuous run topped out at just 8.47 miles for the year.
Despite notching one of my lowest running volume years, I still felt my fitness was good. True, I was able to continue rollerskiing, including intervals, but the break from running left me at least as strong, if not stronger. It made me wonder if walking is better exercise than we might think. Perhaps it’s not as good as running, but it shouldn’t be underestimated.
By 2024 my tendonitis was mostly feeling better. In the spring, coming off a very short ski season owing to the warm winter, I got right into running intervals. My fitness was very good having spent a couple weeks at altitude and my posterior tibial tendon was feeling great. My tibial tendonitis wasn’t bad enough to comment on in my training log, but there was some tenderness in my inside lower calf that responded well to a deep massage 1-2 times per week.
In July of 2024 Ben hosted his annual Backyard Ultra again. I was determined to go 20 miles. I was running up to 10 miles prior to this although granted, with a bit of tendon stiffness following the runs. To hopefully counteract my running, I heavily massaged the tendon the night before the event. The night after the event my tendon was definitely stiff but after I did another deep tendon massage, it felt fine the next morning and the following day I ran almost 6 miles without issue. I went a couple months without any morning tendon popping.
I thought maybe the tendonitis was behind me at this point and prepared to complete this post, but nope, the tendon started popping again in the morning. I backed off the running a bit for a couple weeks - nothing fast and nothing over 8 miles and when it didn’t get any worse I went back to intervals and runs up to 10 miles but with the uptick in tendon popping, I wasn’t sure the tendonitis was gone for good.
This April (2025), I had a mild flare. It was really frustrating to me as it was happening at less than 5 miles and I couldn't run more than 18 miles a week spread over three runs. I backed off the running, gave it a couple weeks, gradually increased the mileage again and things were OK.
Which brings me to now. My tendon is markedly better and I’ve been beating up my legs and especially lower leg muscles pretty hard, often running several days in a row as well as adding in bounding and my jumping/plyos stuff. Like often doing this 4 days in a row. Even doubling in the same day. Sometimes the next morning my tendon pops a few times inside my ankle and will feel stiff. I’ve felt some soreness on the inside of my lower calf and have thought about massaging it, but the soreness never lasts and I haven’t reverted to massaging it in months. The tendon popping keeps me from really pushing the mileage, especially too quickly.
 |
| Running through Riquewihr, France this October. |
I would like to be able to run more than 10 miles in one bout in my future, and I’ve been thinking about a half marathon and actually doing an ultra-distance at Ben’s Backyard Ultra next year, but we’ll see if the tendon cooperates if I gradually ease up the mileage.
At this point, over five years into my journey with posterior tibial tendonitis I’ve come to realize it is unlikely an injury I will ever be able to put in the rearview mirror. Perhaps had I not been so stubborn and stupid when this first happened and had I took the proper rest initially it wouldn’t have become this chronic problem. I guess we live and learn and for a Type A Overachiever, it’s hard to learn this without doing some damage to my body.
