Forums >Health and Nutrition>Post-tib tendon or tibial stress fracture
I've been dealing with what an orthopedist told me (per MRI results) was a grade 2-3 tibial stress reaction in my lower left leg since late August. I had gone to get it checked out because I'd been dealing with consistent swelling and minor, diffuse discomfort in and around my lower left calf for most of my summer marathon training. At no point during my recovery process have I been in a lot of pain, but the swelling really hasn't subsided much, and when I've gone out to run for even 5 minutes, the swelling becomes more pronounced, and so I've had to continually start and stop my return to running for the last 2.5 months. Super frustrating.
I'm starting to wonder if I was misdiagnosed, as I've read more and more about post-tib tendinitis. I have:
-Extremely flat feet
-Had off and on left calf issues (as serious as a strain about a year ago and as minor as constant calf aches and pains when marathon training)
-In the last two years weened off of my 12 mm drop stability shoe into a rotation of 2-3 pairs of 4mm drop shoes
-Been lazy about getting a new pair of custom orthotics. The ones I was in are from 2010 and are likely completely compromised.
-Little to no pain at any point in this process while hopping up and down (which is usually a precursor to a stress fracture)
-No pain while pressing down on the bone. .
If this were really a stress reaction, given the time I've spent away from running, you'd think that by now I'd be able to slowly ramp up again.
Any thoughts? And, any ideas on next steps. I'm thinking:
-Get re-fit for custom orthotics
-Go back to my Mizuno Wave Inspires (12mm) that I had worn for years before the transition
runktrun
There's a lot to dive into here, but quick thoughts:
1. The way you describe starting and stopping your training suggests that if you did have a bone stress injury, you didn't rest enough to let it fully heal. The wording "stress reaction" can give a false sense of security - "oh great, it's not a stress fracture yet!" Wrong. Bone stress injuries are more a continuum of degree of compromise of the bone. There's no line in the sand. Grade 3 usually means the doc could actually SEE a discreet line indicating a break, so Grade 2-3 is still kinda bad. Probably warranted a boot or being very mindful of weight bearing even while walking for a few weeks. How long did you take off from all activity and how long did you take off from running?
2. The swelling does seem odd for a bone stress injury, but it also seems odd for a long-term tendinopathy. Usually long term tendon issues deteriorate from an -itis (with inflammation) to an -osis (tissue break down with no inflammation). What have you been doing to treat the inflammation/soft tissue problems?
3. I think treating this yourself as though it were a post tib tendinopathy conservatively for a few weeks is a good place to start. That means no running. If it's bone injury - no running. Duh. If it's post tib - no running because continuing to run on a compromised tendon will send you into a death sprial of stretching it, scarring it, stretching it, and edging on permanently losing the supportive foot structure of your arch. The post tib basically pretensions your foot to allow it to spring back when you load it and toe off. You should also work on achilles/post tib/general ankle strengthening, but only do the exercises if there's no pain. Start with things like the ankle alphabet, unweighted ankle inversion and eversion, dorsiflexion and planter flexion. Discomfort with inversion points more to post tib issues. If it's bone, then these exercises will still help stabilize your lower leg. Progress to using a resistance band with the exercises, then progress to load bearing, like heel raises standing on both legs, heel raises standing on one leg, heel drops off the edge of the stairs. All these things are good to do even if you don't have post tib tendinosis. BUT, be cautious. I'm not a doctor, just well read and experienced. If you don't see ANY improvement after a week of no running and simple exercises, then probably time to see a sports med doc or PT to work through your issues.
New shoes and orthotics aren't a bad idea either, but be careful about suddenly changing too many variables all at once.
Not running for my health, but in spite of it.
Appreciate the thorough response! To respond to your points:
1. That's what I've feared and you're probably right. I was surprised they didn't put me in a walking boot given the diagnosis. The ortho told me to take a month off and try a slow return to running, but it was clear I needed more time than that. I've since (late September on) been on a series of 2-3 week hiatuses from running, then trying a slow return and seeing an increase in symptoms (swelling, some diffuse discomfort even when just resting during the day). I know insanity is doing the same thing over and over again, so I probably need to commit to even more time off. I also was told after the diagnosis that I could pretty much jump right in to biking/swimming, and so I took no time completely off from cross-training. Assuming that might be part of it, too.
2. I can't really understand the persistent swelling, either. Pushing down on that swollen spot doesn't hurt, but swelling increases with lots of walking or those short "comeback" runs.
3. I'll take your advice through the New Year and then get to a PT and/or get the injury reexamined.
Time off always seems excessive at first, but in hindsight isn't so bad.
I would use pain/discomfort as your guide, even for cross training. Any pain during or AFTER activity should be a sign to back off. Wait until you have a few days in a row of NO PAIN at all to try said activity again, whether it's swimming, biking, or running. Good luck. Try to just enjoy the holidays without the need to run!