Posterior Tibial Tendinopathy

I've posted often about experiencing stiffness or pain in the ankles after some of my longer runs.  Yesterday's long run was no exception. I'm beginning to worry about it, especially as my long runs approach 20 miles. Being 90 days out from the marathon, I probably need to address it now or risk not being able to give it a good go.

The severe ankle sprain last September was to my right ankle.  But this ankle discomfort I'm experiencing is to both ankles, and is even a little more pronounced in the left ankle.  I first noticed it during the recuperation period from the ankle sprain, curious as to why the left ankle was hurting when it was the right ankle that was stressed.  I figured back then that it might have something to do with the added strain I was putting on the left foot while favoring the right.

This weekend, after a little research, I'm now tending to believe that I'm feeling the effects of posterior tibial tendinitis.  The question is "why?" and "what to do about it?"

I felt the ankle weakness start to come on around mile 14 or 15 of my Saturday run.  I was running in my newer Sauconeys, which I've been suspecting for a little while now were the culprits.  My older Sauconeys didn't seem to be associated with the pain so much.  My amateur analysis was that the new shoe's collar was higher and impinging under the ankle protuberance -- the medial malleolous or inside ankle bone.

Now, I'm not so sure.  I think I may be over-pronating and, with added miles, am aggravating the tendon.

I'm going to have some others take a look at my gait, but what I thought was a neutral stride might, on closer inspection, be over pronation. I went back and grabbed some stills from some earlier video I had taken on the treadmill:

 

I never realized my ankle collapsed that much.  I do know that my arch is a little bit flat.  And I can see in the motion video that my toe drifts inward after the push rather than straight or outward as it would if my stride were neutral.  

If I am over pronating, it's not (so far) creating problems with my knees, shins or causing other common runner problems.  But that posterior tibial tendon does appear to be under stress, and as my mileage increases, so will the tendency toward tendonitis.  (Weakness in that tendon might also be a factor in my lifelong tendency to roll my ankles.)

The first thing I plan to do, regardless of the cause, is to cut back and allow my ankles to rest a little.  This is scheduled to be a cutback week anyway.  I'll just bring it back a little more than I had planned.  I already have a pretty good stretching routine, but  I'm also going to give some recommended ankle strengthening exercises a try.  As well, I'll be getting some advice from the running experts at Laces on how I'm running and if my choice of shoe could be contributing to the issue. 

I've got time right now to make some changes without disrupting my marathon program.  I'm entering 20+ mile training run territory where the problem is going to become more pronounced and potentially chronic if I don't address it now.

No recovery run today.  Besides the ankles, yesterday's run really wiped me out, which is strange to me, considering that it wasn't much of a mileage increase over last weekend and I relied on a run/walk strategy to get through it.  I had thought I'd do a non-taxing, flat trail run of 4-5 miles today, but decided the wiser thing would be to stay off the legs and feet completely.  So that's what I did.  

Ate a ton, too.