Physical Therapists Using Clinical Analysis To Discuss The Art And Science Behind Running and The Stuff We Put On Our Feet

Post Page Advertisement [Top]

Running Shoes for Posterior Tibial Tendon Problems
(shoes with stability and medial guidance)

Our perspective on stability and guidance are one of the many things that make Doctors of Running unique. I, Matt Klein, generally need at least mild stability in my footwear. Like many of our readers, I have continued to navigate and understand what a stability shoe is, what options there are out there, what actually provides stability/guidance and who stability actually works best for. Recent research has suggested that stability shoes tend to benefit those with a history of pronation-related injuries or who are unable to control the natural pronation motion during gait (Malisoux et al., 2016; Williems et al., 2021). One of the primary muscles responsible for controlling and that can be injured with poor control of pronation is the posterior tibialis. Those who experience pathology in this muscle/tendon often find relief and comfort with stability shoes and we have put together a guide on shoes that may help those who struggle with injuries or problems with this tissue.

Written By Chief Editor Matt Klein
Edited by Content Manager Bach Pham

What is the Posterior Tibialis

The posterior tibialis is a deep muscle in the back of the lower leg. It is long, starting at the back of the tibia bone, transitioning down toward the inner side of the ankle and inserting on several of the medial bones of the ankle, most notably the navicular bone. The function of this structure is to plantarflex and invert the foot, playing a large part in the control of the back half of the medial arch. It is most active during the stance phase of gait (foot on the ground) where it eccentrically controls pronation during the first half of this phase and assists with resupination and push-off. 

About Posterior Tibial Tendinopathies

Posterior Tibial Tendinopathy is a pathology of the tendon of the posterior tibialis. Given the eccentric stress that this structure experiences, the tendon is more commonly irritated compared to the muscle belly. Posterior tibial tendon issues are somewhat common with 1-16% of runners experiencing them (Kakouris et al,. 2021). Posterior Tibial tendinitis refers to the acute irritation, although with tendon problems, they are more often chronic, called tendinosis. Many tendon problems start without pain and true symptoms only being long after the pathology develops.

Given that the posterior tibialis helps control pronation, this muscle needs to be highly conditioned and strong to tolerate the loads associated with running. Eccentric motions, or muscle/tendon contractions while being lengthened, generate some of the highest tissue loads on the musculoskeletal system. There are many contributors to issues with this tendon, but overtraining, poor lower extremity strength, compensations, excessively pronated feet (not always) poor control of pronation and unstable shoes are all contributors to overuse and irritation of the posterior tibialis tendon (Malisoux et al., 2016; Wang et al,. 2020). 

Treatment specifically of this tendon involves unloading of it with some kind of medial stability (arch support, medial post, guidance, etc) during the early stages to allow healing and then reintroducing load tolerance through appropriate strength and power training (Ross et al., 2016). Teaching the muscle/tendon to be able to tolerate the eccentric stress through appropriate eccentric loading followed by appropriate plyometrics (when ready) to transition from control of pronation to the push off/resupination phase is critical for success during rehabilitation. Unfortunately, most people do not appropriately rehab or complete rehab, which may influence why recurrence rates are quite high. 


Kakouris, N., Yener, N., & Fong, D. T. (2021). A systematic review of running-related musculoskeletal injuries in runners. Journal of sport and health science10(5), 513-522.

Malisoux, L., Chambon, N., Delattre, N., Gueguen, N., Urhausen, A., & Theisen, D. (2016). Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. British journal of sports medicine50(8), 481-487.

Ross, M. H., Smith, M. D., Mellor, R., & Vicenzino, B. (2018). Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ open sport & exercise medicine4(1), e000430.

Wang, J., Mannen, E. M., Siddicky, S. F., Lee, J. M., & Latt, L. D. (2020). Gait alterations in posterior tibial tendonitis: A systematic review and meta-analysis. Gait & posture76, 28-38.

Willems, T. M., Ley, C., Goetghebeur, E., Theisen, D., & Malisoux, L. (2021). Motion-control shoes reduce the risk of pronation-related pathologies in recreational runners: a secondary analysis of a randomized controlled trial. journal of orthopaedic & sports physical therapy51(3), 135-143.

Posterior Tibial Tendinopathy and Medial Shoe Stability

Evidence suggests that those who have a history of pronation related injuries, including posterior tibialis tendinopathy, may benefit from using stability shoes. Stability shoes generally refer to footwear that feature some kind of technology or geometry meant to support the arches of the foot and help control the rate of pronation (evidence suggests it helps you control the speed, but not necessarily how much). This technology will be seen on the inner or medial part of the shoe. Different technology that provides medial support includes medial posts (harder density of foam on the medial side to support the foot), medial sidewalls or guiderails (raised parts of the sole that provide resistance to the inward roll), plastic cages or rods that provide stiffness and resistance to the inward roll of the foot, medial sole flare and having the midfoot section of the shoe filled (rather than cut away). Over the last several years, stability shoes have begun to decrease in number.

There are still several present and fortunately a new category (at least, something we categorize) called "stable neutral" has risen. This is another option for those with mild stability needs as some of these shoes provide stable, guided elements that will work for those with stability needs, especially medial stability needs as those with posterior tibials tendon issues do.

The final thing to keep in mind shoe-wise with posterior tibial tendinopathies is that higher drop shoes tend to be better. As the posterior tibialis is also a plantarflexor muscles like the calves, the lower drop (difference in height between the front and back of the shoe) the more range of motion and stress the muscle/tendon have to go through. Especially during the early stages of irritation, higher drop shoes will be better for this pathology.

Running Shoes with Medial Stability
(Click to Learn More About Each Shoe)

Shoes with High Levels of Stability
(For those with excessive motion wanting a high level of control, high level stability shoes may be helpful, although have decreased in number. These are often a bit heavier but are also usually highly cushioned with strong medial support elements from posts, guiderails, sidewalls and more)

Highly Cushioned Trainers
Brooks Beast/Ariel GTS 23
(A very prominent guide rail system that goes through most of the shoe with a wide base)

Shoes with Moderate Levels of Medial Stability
(For those with moderate motion wanting medial stability, moderate stability shoes may be most helpful. Many of these shoes have been mainstream for years and are extremely common/popular among runners. This is often the best place to start when trying on stability shoes)

Highly Cushioned Stability Trainers
Mizuno Wave Horizon 7
(dynamic stability system with strong medial support)
Brooks Glycerin GTS 21
(guidance based, high cushion trainer with a minor medial post within the guiderail)
ASICS Gel-Kayano 30
(Width-based stability without a posted system)
Saucony Omni 22 (review coming later)
(A revamp of last year's Saucony Guide with a Hollow Tech post)

Normal Stability Trainers
Brooks Adrenaline GTS 23
(guidance based, moderate cushion trainer with a minor medial post within the guiderail)
ASICS GT-2000 12
(A slimmer version of the Kayano 30 in a moderately cushioned package)
Mizuno Inspire 20
(A wave plate helps provide rearfoot stability)
(A classic posted stability shoe, now rare in the market)
Topo Ultrafly 5
(The only low drop medial stability shoe)

Performance Trainers
Saucony Tempus
(Featuring a dynamic stability setup using different mechanics to create stability. Prominent arch)

Shoes with Mild Levels of Medial Stability or Stable Neutral Shoes
(Shoes with mild stability elements, like small posts/guiderails or are stable neutral, including wider soles and higher medial sidwalls and natural guidance elements, are for those who are too sensitive to moderate to higher levels of stability but still want some mild guidance)

Mild Stability Trainers
Saucony Guide 17
(A wide base, lightly medial stability trainer that's on the lighter end of stability shoes)
On Cloudflyer 4 
(A geometry based shoe that also is on the firmer end for stability)
Nike Structure 25
(A very mild stability trainer with width and firm outsole being two mechanics to hold the shoe together0

Stable Neutral Trainers
Adidas Adistar CS 2
(A prominently wide base and firm sole define the CS 2)
Mizuno Wave Rider 27
(A classically stacked trainer with a wave plate that provides rearfoot stability)

Mild Stability Performance Trainers
Brooks Hyperion GTS
(Old school racing flat with a faster foam and minor guiderails helping center the runner)
Brooks Launch GTS 10
(A low stack trainer with minor guiderails. Low stack adds to feeling of stability)
ASICS Superblast (Not stability, but stable neutral)
(A monster stacked shoe that is balanced with a wide base)

Racing Shoes (Stable Neutral)
Adidas Adios Pro 3
(Carbon plated racer that pitches runners laterally, away from medial)
Brooks Hyperion Elite
(This racing flat has a firmer sole and decently wide base for support)
Saucony Endorphin Elite
(Carbon plated super shoe with some stable elements that help make it more supportive than most racers for the marathon distance)

Have questions? Send us an email at

Thanks for reading!

Follow Doctors of Running on Social Media

Facebook: Doctors of Running 
Youtube Channel: Doctors of Running 
Instagram: @doctorsofrunning 
LinkedIn: Doctors of Running
Strava: Doctors of Running
Podcast: Virtual Roundtable
Pinterest: Doctors of Running

Bottom Ad [Post Page]

// ]]>