Posterior Tibial Tendonitis
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There are numerous tendons, ligaments, and nerves that can cause inner ankle pain running. In this article, we are going to discuss the main conditions that cause inner ankle pain when running, their symptoms, and how they are treated.
The Posterior tibial tendon is a long narrow tendon that runs down the inside of your shin, along the inside of your ankle and connects to the medial arch of the foot. The primary function of the Posterior Tibial Tendon is to act as a stabiliser of the inner ankle when walking or running. It plays a significant role in the eccentric phase of pronation when running. As a result, a sudden increase in running volume, repetitive overload, or a change in running speed or volume can cause Posterior Tibial Tendonitis.
It may be constantly painful in acute symptoms following a sudden change in running regime and a return to running after rest. It may be painful after the run and is typically tender and stiff when getting out of bed the following morning. In sub-acute cases, it is more common to have a dull ache at the start of a run that eases as the tendon warms up.
Treatment can consist of strengthening exercises, guided by a Physical Therapist, Load Modification, increasing the rest days between runs and reducing the speed or hill sessions in a training plan. Other treatment methods may include changes in footwear, custom insoles, and gait analysis.
The Flexor Hallucis Longus Tendon runs down the inner side of the shin bone beside the Posterior Tibial Tendon. Its primary function is to flex the big toe and, in doing so, plays a crucial role in propulsion when walking and running. An overload of this tendon can lead to Flexor Hallucis Longus Tendonitis. Alongside runners, Flexor Hallucis Longus Tendonitis is very common in dancers.
Pain can be located to the inner ankle when running, while sometimes it may move further down the underside of the foot where it connects to the big toe. It may be stiff and tender at the start of a run, easing as it warms up. It can often be painful and stiff in the morning after a run.
The first line of treatment is a strengthening program guided by a Physiotherapist. It can be helpful to modify your training regime to increase rest days between runs. Changes in footwear and reduction in hill training can also be helpful.
The Medial Malleolus is the protruding bone on the inner ankle. It is connected to the talus bone via the medial ligaments and to the fibula via the anterior tibiofibular ligament. The Medial Malleolus plays a significant role in weight bear when running. Running styles that place more weight through the medial ankle can cause a stress fracture of the Medial Malleolus. This is more common in those with low bone density or vitamin D levels.
Onset can develop suddenly during a run, or patients often report constant pain after a run. It is often painful with all weight-bearing activities, and there may be bruising and swelling in the area. The bone is often tender to touch or tap around the site of injury,
An x-ray usually achieves diagnosis; if it fails to pick up a Medial Malleolus Fracture, then a Sports Medicine Doctor or Orthopaedic consultant may request an MRI or CT-Scan. Treatment usually consists of 4-6 weeks in a boot, and blood tests may be requested to check vitamin levels. 4-6 weeks of Physical Therapy are carried out once the boot is removed.
The posterior tibial nerve runs down the inner shin bone and wraps around the inner ankle through a tarsal tunnel. Sub-optimal biomechanics or a traumatic event such as a medial ankle sprain when running can lead to compression of the posterior tibial nerve and sharp burning pain in the inner ankle. This is known as Tarsal Tunnel Syndrome.
If there is no trauma, treatment includes gait analysis, stability exercises, mobilisations by a Physiotherapist, and in some cases, custom insoles. In irritable cases, an injection may be required to reduce inflammation in the area.
The Deltoid ligaments connect the medial malleolus to the talus bone. The deltoid ligaments are a robust web of connective tissue, and together with the articulation of the surrounding joint, they provide tremendous stability to the inner ankle.
Rolls or twists on uneven pavements can lead to stress being placed on the deltoid ligaments. This can also occur from running on a camber. Irritation of the deltoid ligaments can lead to synovitis on the inner ankle, causing pain deep within the medial ankle joint.
A Physical Therapist’s treatment includes ankle mobilisations, stretches, strengthening exercises, and stability exercises. Modifications to training and changes in the footwear of custom insoles may be required to offload the inner ankle when running.