Rob has an issue with his Tibialis Posterior

August 4, 2016


I started to take up running again a few months ago. I was getting close to running 4K non-stop, when I started experiencing pain in the instep of my foot and up into my ankle. This pain lasted for a few days but then returned if I ran or walked for any significant distance. I do wear orthotics in my shoes, but they don’t seem to prevent the pain when running.



But the Guru requires more information:

Sounds like your making good progress – and starting to receive all the hidden benefits from exercising too.

Give me a little more insight into how often you run, and for how long? What shoes do you run in and how old are they? What do you wear the orthotics for?

It sounds as if you may have an issue with your plantar fascia, but that rarely gives pain into the ankle – just instep. It can feel as if you’ve trod on a pebble.

Lots of things can be done, but just need a few more clues to fine tune the answer.

So Rob responds:

I was seeing a Physio about six months ago…and they recommended the orthotics as they said it looked like my foot rolled in a bit when running and walking. I also happened to have inner knee pain at the time on the same leg which was brought on by running but which has eased up now. The orthotics seemed to help for a while but once I took up running again, the pain in the foot/ankle came back.

The pain and tingling comes on after a run or strenuous walk along the side of the instep…it’s more along the side edge of the foot than underneath it. It also goes from the instep, up past the knobbly bit of my ankle and sometimes up into my calf muscle. The area can ache for a few days afterwards as well.

I have been doing a beginners 5k programme where I was running/walking for 30 minutes, three times a week. I run in Saucony trainers which I bought after having a gait analysis. I also run with the orthotics in the trainers.

Sorry for the long email and thanks again!

August 4, 2016

Thanks Rob

Slight change of tact from your new info – I think this is an issue with a muscle in your foot called Tibialis Posterior.

The issue about getting pain in different places, all within a short time period leads me to believe that the Physio before was doing a really good job at making you feel better, but didn’t actually get you any better. The cause of your knee pain is still out there and the symptoms have just shifted elsewhere.

It’s not about symptom relief, it’s about getting your really better – long term.

I’m pretty sure you need to drop back to basics – your knee hurt because you lack control around your hip that makes your thigh roll in. This increases the stress through your knee, and can be painful. It’ll also cause your foot to roll in more than the other. Bunging in an orthotic helps control the foot (if it needed control) and stops the knee rolling in. It doesn’t change the why – the control of the hip.
Your tib post muscle helps lift your arch and controls the rolling in of your foot – like the orthotic, but like the orthotic can’t deal with the extra load when running, because you still don’t have control around your hip – your gluts.

Don’t be misguided into getting stronger gluts, but get more control and then get stronger. Have a look at our video

Ease the running down – run 15′ walk 5′ run 15′. Get on a bike. Improve your balance by standing on 1 leg and then think about binning the orthotics. You’ve got a functional issue not a structural one.

The Guru

Guru Responded

Have more questions?

If you're struggling with Hip, Knees, Running issues then we'd love to help. We offer appointments within 24 hours whether face to face at one of our London Physio Clinics, virtually or if you’d prefer we can arrange a home visit.

Request An Appointment

We aim to get back to you within an hour

How should we contact you?