PTTD in Runners: Managing Posterior Tibial Tendon Dysfunction as an Athlete

Running is hard on your feet. Every stride sends shock through your arches, your tendons, your joints. So it’s not surprising that posterior tibial tendon dysfunction is relatively common among runners. The good news? With the right approach, many runners with PTTD can continue doing what they love—sometimes with just a few modifications.

Why Runners Get PTTD

The posterior tibial tendon takes a beating during running. It acts like a pulley, supporting your arch and helping you push off efficiently. In running, this tendon handles forces several times your body weight with each footstrike.

Several factors make runners particularly vulnerable:

Overuse

Increasing mileage too quickly is the most common trigger. When you ramp up your training faster than your body can adapt, the tendon becomes inflamed and irritated.

Biomechanics

Runners with flat feet or overpronation put extra stress on the posterior tibial tendon. The tendon works harder to compensate for the lack of arch support.

Surface and Shoes

Running on hard surfaces like concrete, wearing worn-out shoes, or switching to minimalist shoes without proper transition can all strain the tendon.

Training Errors

Hill repeats, speed work, and increased intensity all increase stress on the posterior tibial tendon.

Continuing to Run Safely

If you’ve been diagnosed with PTTD, running isn’t necessarily off the table. The key is modifying your approach:

Reduce Mileage and Intensity

This is the most important change. Consider cutting your weekly mileage by 30-50% initially. You can build back gradually as your tendon heals.

Avoid Aggravating Factors

  • Skip the hills: Running uphill dramatically increases stress on your posterior tibial tendon
  • Choose softer surfaces: Grass, dirt trails, or tracks are easier on your feet than concrete
  • Shorten your stride: A quicker, shorter cadence reduces the load on your tendons

Prioritize Recovery

  • More rest days between runs
  • Ice after running if you notice any swelling
  • Rolling out your calves and arches regularly

Get Proper Footwear

This isn’t the time to run in worn-out shoes. Look for running shoes with good arch support, or consider custom orthotics. Some runners benefit from stability shoes that limit overpronation.

Cross-Training Options

While you’re managing PTTD, other activities can keep you fit without stressing your posterior tibial tendon:

  • Swimming: Zero impact, full body workout
  • Cycling: Lower impact than running, but still provides cardio
  • Elliptical: Simulates running motion with less stress
  • Pool running: Running in water dramatically reduces impact while maintaining running mechanics

Return to Running Protocol

When you’re ready to start running again after recovering from PTTD, take it slow:

  1. Start with 1-2 short runs per week (10-15 minutes)
  2. Keep intensity low — you should be able to hold a conversation
  3. Increase by no more than 10% per week in either distance or time
  4. Skip hills and speed work for at least 4-6 weeks
  5. Pay attention to symptoms: Any return of pain means backing off

Prevention: Protecting Your Tendon

If you’re a runner who wants to avoid PTTD—or prevent it from coming back:

  • Increase mileage gradually: The 10% rule is your friend
  • Replace shoes regularly: Every 300-500 miles
  • Strengthen supporting muscles: Calf raises, toe exercises, and hip strength work all help
  • Don’t ignore early symptoms: A little arch pain today can become a major problem tomorrow
  • Consider gait analysis: Understanding your biomechanics can help you choose the right shoes

When to See a Sports Medicine Specialist

If conservative measures aren’t helping, or if your symptoms are getting worse, it’s time to see someone who specializes in athletic foot and ankle problems. They can:

  • Confirm the diagnosis and assess severity
  • Provide advanced treatment options
  • Create a personalized return-to-running plan
  • Rule out other conditions that might be causing your symptoms

Sources

  • American Academy of Orthopaedic Surgeons (AAOS) - Posterior Tibial Tendon Dysfunction
  • Sports medicine literature on running injuries