The hike is over, thanks tendinitis

This was supposed to be the time when I write my glorious “I did it” post, but unfortunately my NOBO hike turned into a LASH. Since July I have been dealing with persistent posterior tibial tendinitis in my right foot and envying all the hikers finishing their journeys via a computer.

The Technicalities of Posterior Tibial Tendinitis

Within a week after my last blog post, I was off the trail. I had noticed the aching and pain on the inside of my right arch the first day after I left home and the comforts of slackpacking. Throughout that day, the aching moved up into the inside of my ankle. I only walked 8 miles that day, 11 the next, and 16 the day after hoping that lower mileage would allow the pain in my foot and ankle to subside. Unfortunately, it only got worse and eventually the pain was shooting up my ankle with every step I took. My last day on the trail I walked only 1 mile from I-72 to Swatara State Park in PA.

I was so bummed. I had finally reunited with my trail family that I had known since Georgia and was really looking forward to hiking with them again. Reluctantly, I called a local friend (very convenient that I lived not far from my stopping point) and asked them to pick me up. I knew I needed to see a doctor. Being a runner and hiker for most of my adult life, I was certain this was not a pain I should be walking through. My body was telling me something serious was going on in my foot. Turns out I was correct to listen to the pain.

I was diagnosed with posterior tibial tendinitis (PTT), which is a common overuse injury. In the months following this diagnosis I have learned so much about the mechanics and anatomy of my feet. PTT is inflammation in one of the main tendons that connects your calf to the bones in your feet. The tendon wraps around the back of your ankle and attaches at various points along the arch and bottom of your foot. This tendon becomes injured when overpronation (your foot rolls inward) happens during your foot strike. It’s a micro injury that starts small and gets worse as you keep hiking and stressing the tendon. Continuing to hike on this type of tendinitis is absolutely a terrible idea. Unlike most other tendons, the post tib works alone and does not have large supporting tendons that can bear the stress of continuing to hike or run when the tendon is injured. If I had ignored the pain and continued to hike, it is highly likely I would have ruptured or torn the tendon causing the collapse of the arch in my foot which is a permanent and very painful condition. Most surgical procedures to fix this are unsuccessful.

When I got off the trail, I had no idea it was my last day. I told my trail friends I would catch up with them in a few days or weeks depending on the results of my doctor visit. Three and a half months later, I am still unable to run or hike and have a low level of pain in my tendon that has not subsided. Recently I had an MRI that showed I won’t need surgery (THANK YOU TRAIL GODS!!), but I will have to return to physical therapy for more treatment. I will also have to be much more diligent about changing out my footwear and insoles on future hikes. It’s likely most of this could have been avoided if I hadn’t walked 1000 miles on the same pair of insoles.  I sincerely hope I can return to running and hiking within the next few months.

It was hard to watch all of my friends complete their AT journeys from my computer screen. I am so proud of them, yet so jealous that they were lucky enough to make it to Katahdin despite all the odds. I plan to finish the trail. I hiked about 1,200 miles from Georgia to Pennsylvania and I’ll have about 1000 more to get to Maine. If I don’t secure a job in my field by next hiking season, maybe I will pick up where I left off or possibly SOBO. It’s hard to say now, but I know the trail is calling me to finish what I started, just with a healthy right foot that won’t be left with permanent damage. Until then I will day dream about the places I’ve been on the AT and look forward to the parts of the trail I left unexplored.


(Shout out to thru hikers: Athena, Bilbo, Catapult, Flo, MoLa, Puma, Safety Pin, Thor, Twix, Ukelady, Wartortle, White Noise – You guys are awesome!! Gone Boy and Rosie – I feel your pain. We’ll finish the trip one day.)

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Comments 6

  • David Tozzo : Oct 27th

    Any particular insoles/shoes/gear/exercises that have been recommended to help this condition?

    • Olivia : Oct 27th

      Well it would really depend on how much your feet overpronate. My therapists recommended a stiff orthotic with a lot of arch support such as Redi-thotics since the shape of my feet cause a lot of overpronation. Any shoes that are designed for overpronators would be ideal. I hiked in Salomon Mission XR’s which I liked but they are not specifically designed for overpronation. I’m looking into Altra Provision 2.5’s which have specific cushioning in the arch. Hiking poles are always recommended to take some of the stress off your feet and knees. Currently I’m doing strengthening exercises that focus on the dorsiflexion of my foot and a lot of calf stretching. Tight calves can cause the posterior tibial tendon to become tight so always stretching your calves is a good idea.

      • Mike : Sep 16th

        Hey Olivia,

        Did you ever solve this issue? I’ve injured my PTT hiking as well and was wondering if you ever found a solution. Would love to hear back. Thank you!

        • Olivia : Sep 16th

          Hi Mike,

          Yes this issue did eventually go away. It took about 6 months of solid rest and 12 weeks of physical therapy. I ended up seeing an orthopedic surgeon and getting an MRI which revealed my tendon was just inflamed and there was no damage or tears in it. I opted to continue PT rather than get surgery. Unfortunately I’m still dealing with this tendinitis two years later. I have had good periods where I can run and hike shorter distances without much issue but it seems every time I up the mileage a little too much it returns. I know an ex-professional runner who struggles with the same issue. My advice is to let it heal fully the first time and really ease yourself back into exercise. You cant overdo the rest on this type of tendinitis. Be prepared for it to resurface even when your foot has been feeling good for awhile. It takes a very long time for it to heal fully.

  • MICHAEL : Oct 6th

    Well……I’m 5 weeks after dealing with the same issue from too much hiking. MRI just indicates tendonitis. Got out of boot one week ago. Can you hike now or still held back every time you do decent mileage? An update would be helpful. I’d hate for my hiking fun to be over now 🙁

    • Olivia : Oct 7th

      I still have issues with my foot when I hike longer distances. I haven’t done any serious long distance backpacking since the AT. I was also often impatient and would hike or run as soon as it felt better and would flare up the inflammation again. I’d suggest taking a long time off (like half a year or longer) and giving it tons of time to heal. Then take baby steps when getting back into it.


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