Can I Continue Running with PTTD? What Runners Need to Know

I want to give you an honest answer: running with PTTD is risky. It’s high-impact and puts significant stress on the posterior tibial tendon. Continuing to run often makes the condition worse—but that doesn’t mean your running career is over forever.

The Hard Truth About Running and PTTD

Running involves thousands of impacts per mile, each one stressing your posterior tibial tendon. If you have PTTD, that tendon is already damaged and struggling. Adding impact can accelerate the damage, potentially pushing you toward surgery.

Whether you can continue depends on:

• Your stage of PTTD — Early stage (1 or 2) has better odds than advanced (3 or 4)
• Your pain levels — Some runners can manage mild discomfort; others can’t
• How much you modify — Cutting back significantly helps

Your Options as a Runner

Option 1: Stop Running Temporarily

• Focus on cross-training (swimming, cycling, elliptical)
• Do physical therapy to strengthen your foot
• Resume running only after PT clears you
• Many runners return successfully if they address the problem early

Option 2: Switch to Low-Impact Activities

• Swimming is perfect—no impact on your feet
• Cycling is gentler on tendons
• Elliptical provides cardio without the pounding
• You stay fit while letting your foot heal

Option 3: Run Less, More Carefully

If your doctor approves continuing:

• Cut mileage significantly — 50% or less of your normal volume
• Avoid hills — Uphill stresses the tendon more
• Stick to softer surfaces — Track or grass is easier than concrete
• Use walk/run intervals — Reduce continuous impact
• Replace shoes more frequently — Worn shoes lose support

If You Choose to Keep Running

If you and your doctor decide you can continue:

• Get evaluated first to understand your stage
• Work with a physical therapist on strength and form
• Ice after every run to manage inflammation
• Never increase mileage more than 10% per week
• Stop immediately if pain increases during or after runs
• Get regular check-ups to monitor progression

The Risk You’re Taking

Be honest with yourself: running can accelerate PTTD damage. You might be trading short-term running enjoyment for long-term consequences—including surgery.

Some runners successfully manage PTTD and keep running. Others push through and end up needing surgery anyway, plus potentially shorter recovery times.

The choice is personal, but it should be an informed one.

The Bottom Line

Running with PTTD is possible for some people in early stages—but it’s a risk. The safest path is to take time off, do PT, and return gradually. If you can’t imagine life without running, talk to a sports medicine podiatrist about your specific situation.