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• Initial treatment usually starts with a significant increase in arch support to prevent or reduce pronation. It helps to use more stable (motion control or stability) yoga shoes, over-the-counter orthotics, arch taping. Don’t walk barefoot, and don’t use unstable everyday shoes. These adjustments will often allow for yoga while the healing is proceeding.
• Icing is helpful for recovery and usually reduces the duration of the injury.
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For 15 minutes every night, rub a chunk of ice directly on the injured area until it gets numb.
• Elastic ankle supports may help, but are not as good as stable yoga shoes with orthotic arch supports. The compression and guidance of an ankle support helps with everyday activities and very mild Yoga Injuries, however. For maximum support use all of the above.
• If there is soreness or swelling in the tendon which runs from the bottom of the ankle bone to the bony inner side of the foot, avoid yoga for at least 3 days. Yoga Injuries that produce mild soreness usually respond to the above-mentioned self treatment. But when there is swelling and strong pain, see a doctor. The tibialis posterior tendon is vital to yoga and walking. A tearing or rupture of this tendon can lead to a fallen arch, arthritis, and often extensive surgery.
• Physical therapy is helpful, but avoid strengthening exercises until the injury is healing successfully. It is difficult to strengthen the tibialis posterior muscle to the extent that it can overcome an inferior inherited foot structure. Long-term strengthening of the feet is very important to decrease the likelihood of reinjury.
• A doctor may also prescribe immobilization with a cast or removable walker. This is advised if the injury is not healing and training is not possible. Gentle activities or non weight bearing motion with crutches is also a possibility.
• A doctor may prescribe an MRI to see if there is a tear or to identify which tendon is injured. This can be helpful if a more aggressive treatment is needed.
• Do not allow an injection directly to the tibialis posterior tendon unless everything else has failed, months of rest have not produced healing, and there is the possibility of a rupture. The other 2 tendons in this area are less risky to inject, but still pose risks. Again, an MRI may determine the location of the damage.
• If a nerve conduction study is recommended (for possible Tarsal Tunnel nerve symptoms) try to find a specialist that has worked with a lot of runners in this area. A positive result from this test may mean the nerve is damaged, but there is no standard treatment when this happens. Surgery will not heal the nerve if it is significantly injured and it usually will not show as a positive study unless it is. The nerve can be injured even when the results say “normal. ? Be sure that your doctor is doing a thorough job of conservative treatment to allow sufficient time for healing to occur.
• Medical custom orthotics are needed if the pain is recurrent, or if the injury is due to poor foot structure, rather than training or shoe errors.
• If very thorough support with good shoes does not seem to be promoting healing, you could have a tear.
• Mild to moderate cases heal very quickly – usually within a couple of weeks.
• When the tendon is significantly injured, healing can take 3 to 4 months.
• If a true tibialis posterior tendon tear (not a rupture) has happened, 6 months to a full year off from yoga is usually necessary in order to avoid surgery. Choose alternative exercise carefully.
• If the tendon is ruptured or stretched (attenuated is the medical term), surgery is usually recommended and long distance yoga sports may not be possible.