Running shoes for posterior tibial tendon issues with low volume fairly narrow feet & inserts

Hi all - I am having some issues in the post tib area, recurring thing that has never been fully diagnosed or long term resolved. Am seeing a new physio who has pushed me towards changing running shoes, hence asking for advice.

Recommended shoes (for anyone in this situation, not specific to me) from the physio are:

Asics - Kayand
Asics - GT2000
Brooks - Adrenaline

He didn’t go into detail why but suggested they are good support type trainers. From gait analysis he suggested my current Adidas Ultraboost are too soft and lack support. From a brief video session it appears I have a slight heelstrike that snaps inwards, although Achilles ends up nice and straight on full foot landing and push through stroke. Side gait again shows heel stroke but otherwise he liked my stride.

Physio would like me to use 6 degree heel wedges, trying these in current trainers feels horrible and they feel like they want to slide off (both rigidity and it raising the heel). With an exercise and rehab programme he says I may not need them long term.

I’ve got what I believe to be fairly low volume feet (i.e. not tall) which are also on the narrow side, but not extremely so. My ankles are slim and Achilles area narrow for sure.

Where I get baffled is arch, midsole drop and of course sizing.

Under Tier 4 lockdown at the moment but even under the current situation I am not likely to go to a trainer shop, so it will be mail order.

Any help is really welcome!

Well pronation or the foot rolling in on ground contact is what most people do, its the bodies natural shock absorbing. I use to run a lot (2:47 marathon, 16 and change for 5k) - I had no motion control issues and ran in the Asics 1000 series as they offered a bit of support near the end of a long run. Most adidas boost shoes have zero support and should be avoided unless you have great biomechanics. The Asics Kayano and 2000 series are more supportive and similar to the 1000 series I ran in with just a few more features. They are the go to shoe for a lot of standard runners. The Brooks Adrenaline is a decent shoe and has similar features to the 2 Asics shoes…and is bio degradable if that matters to you! :laughing: The ultimate support shoe which you should consider before trying non prescribed orthotics is the Brooks Beast - bit heavier, not exactly fast but has been the go to motion control shoe for all runners with compromised biomechanics for 30+ years.

Great help thanks.

I have found a local store that sells Brooks so when it is open again, and we can leave home, I should be able to try the regular width at least.

I’m not fast so maybe the Beast is worth a try.

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For rehab: progressive deep calf stretches for recovery, heel dips, 1 legged body weight dead lifts, and arch exercises for building up feet/ankle stabilizers and tendon strength.

For shoes: I have wide flat feet and use Asics trail shoes with high arch inserts. But, I’m a forefoot striker. So these may not apply to you being a narrow foot heel striker.

Weak feet stabilizers and weak arch seems to be my focus points towards PTT recovery.

Also, I found that treatment is similiar to plantar flacitis.

Last, hard bike rides tends to not hurt PTT.

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I struggled with a posterior tib issue for like a year. I worked on gait, especially engaging my glutes. I slowed down my pace, too. I use the Mizuno wave inspire which is, I believe, a stability shoe, with the old style green Super Feet support inserts. I have small ankles and a bony foot and the shoe and it’s predecessors have worked for me.

Thanks for this post. It reminded me to do my hip bridges!

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I have narrow, low volume, flat feet and have worn Brooks Adrenalin for many years. Fit like a glove and I have not found another brand that fits as well. I use Superfeet Black inserts in mine.

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I tore mine several years ago in a European XC race and ended up getting some help from Mayo Clinic after suffering for a year. Depending on how bad yours is there could be some scar tissue on the tendon that needs to be smoothed out by deep massage, Graston ect to break it up. Hopefully that’s not the case. I also used a AFX exerciser to strengthen and improve range of motion.
Your narrow foot creates a fit challenge. I use to manage a run store which specialized in gait analysis and I also taught running biomechanics.
You might benefit from working into zero drop shoes occasionally but not for running right away. The challenge with this injury is just resting it for 4-6 weeks (which just tightens the tendon with out doing some active therapy) and then returning to running usually brings it back.
You might give the NB More shoe a try in narrow.
It’s a bit bulky but light weight and has a rocker sole which sometimes help give some relief. If you have a treadmill video your running from all 4 sides (front,back,both sides and post it on here.
Seeing how you run would be helpful.

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With the ongoing UK lockdowns I haven’t made any progress with this. I can actually access a treadmill but unsure when.

I did manage to try a pair of Asics shoes but they are too wide / high volume for my feet, suggesting unless their women’s fit is narrower it’ll be time to look at the narrow fit Brooks, and in my rough size it’s only an Adrenaline available.

Looking like I need to buy a couple of sizes online then return the others, not something I am that into when could have just shopped locally but this lockdown isn’t ending anytime soon.

Hi there

I have also had PTT issues brought about presumably by cycling

With regard to the shoes, it’s not so important as long as you get something that bends at the toe and is otherwise stiff soled. I ended up in some brooks adrenaline GTS. Then a medial heel wedge to offload the PTT and an arch support orthotic (slimflex 3/4 high density available online uk from shoe insoles). That was from a sports podiatrist

It’s a long term injury, so be prepared for the ups and downs. I’ve had good success with rolling calves but not stretching them and also doing eccentric holds on one leg on my tiptoe. Mine was bad for nearly 3 months, I rode again for 3 months and now it’s flaring again. It ends a lot of running careers (I don’t run) so take it seriously.

Boombang - I’m part-way recovering from post tib tendontis overuse injury. After a month I’m walking without pain and have just started test running. Most successful shoe so far is ASICS Glideride. I thought Hoka Clifton 7 would be best but seems to be too soft and this may be causing the ankle to work harder. No matter how much arch support I put in Clifton it is not as good as Glideride. Both have rocker soles. I think the key to the Glideride is the rocker sole and that it is not too cushioned. Also a DIY arch support helps even more. Its width suits my foot. Kayano 26 just doesn’t work because the heel is not connected to the forefoot. No smooth transition.

Thanks for all the info guys, appreciate it.

Have been quiet as I can’t get anywhere to try shoes, not sure what width or size I need, and don’t want to buy 6 pairs to return 5 (or all!).

I’ve been working with my physio on exercises but also a neuromuscular specialist.

The specialist did a quick ultrasound assessment of the left foot and tendons and found nothing to suggest post tib issues apart from the pain.

Given the various injuries, aches, pains, he ended up sending me for a thoracic, lumbar, SI joint and ankle MRI - nothing quite like an hour in a tube!

It’s a wait and see for now I guess.

Upshot of MRIs and diagnosis with musculoskeletal specialist is there isn’t anything terribly wrong.
Bit of disc wear, perhaps a slight thickening of post-tib but no baseline to compare with.

Ankle issues perhaps are down to the shoes, wider back issues put down to stress, posture, working arrangements - basically my working lifestyle.

Really happy nothing fundamental is wrong but this isn’t easy to sort especially at the moment. If it was just me I would massively downsize house and have a total lifestyle change including job - but with dependants, challenging job market and looming recession/mass redundancy I got to suck it up and roll with the punches.

Either way I’ve jumped back on the bike and doing 15 min sessions, next week up to 30 and then take it from there. I will sort this.

A little late but one thing worth considering is that although support shoes are often recommended, there is little to no evidence they actually do anything. There are studies showing that even when a runner who pronates wears a support shoe, they still pronate just as much as they would in other shoes. What you are more likely to benefit from in this case is a lighter, firmer shoe. Why? Well, your body will innately try to land lighter and more efficiently when landing on a “harder” surface (think how you react if you jump and land barefoot on a mattress vs concrete, one you make substantial adjustments for). Increased cadence is also a better bet. Higher cadence correlates with lower vertical loading rate which will put less stress on your PTT. As others have also noted, strengthening exercises are your best bet long term. Hopefully you are feeling better and able to get more going!

I actually have some trail running shoes that are exactly that - very firm, stiff sole, very light uppers.

The physio asked me not to run until I have better supporting shoes that I can fit heel wedges in temporarily. I’ve read articles/studies too but am following his advice to the letter as can’t do any harm.

In theory if it is the shoes I could just run barefoot on the treadmill, albeit taking it very easy to let the foot get used to zero support.

I’m wearing a pair of super comfy Brooks Ghost 11 right now. I’d also suggest some gel arch supports that you can wear with any shoes. There are some that are attached to a wide elastic band that goes around your arch so you even get support when you aren’t wearing shoes, like if you’re walking around the house or putting your feet up on the couch. Link to shoes for arch support that I highly recommend!

Have had PTT issues for a few months now, and in my case nothing worked as well as elastic band work (mostly eccentric exercises, but all directions were useful) to strengthen the tendons. On shoes, I reckon any stability shoe that fits you well should do the trick. For me it’s the Altra Paradigm 6 (I love low/zero drop shoes).

What sort of elastic band exercises did you do? Did they focus on the PTT itself, or on other things (my PT told me to work on strengthening the glute medius, for instance)

aside from the usual stuff for hips/glutes activation (which, together with insufficient foot muscle, is often the cause for PTT issues), I do inversions, eversions and extensions with the band. All the info is available here