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Patient with an LLD of 15mm (L>R) and a history of chronic lower back pathologies (Tx by chiropractor)
Patient is a seasoned long distance runner (ultra marathons). Transitioned from traditional running shoes with a heel strike to minimalistic running with a forefoot strike two years ago.
Lower back pathologies have now greatly improved with a lower incidence.

Patient has now been suffering with various Left ankle soft tissue pathologies for which he has received physiotherapy over the last one and a half years. However, once one pathology is resolved, another will set in.
Currently, patient has Left Achilles tendinopathy at insertion.

Biomechanics are relatively sound, other than the LLD.

My questions are...
1. Could an LLD in forefoot running style cause extra strain on the soft tissue around the ankle of the longer limb?
2. What are my treatment options for this, without reverting to traditional running style in traditional running shoes?


Thanks in advance...

 

If I assume he was pretty much injury free you answered your own question

2. What are my treatment options for this, without reverting to traditional running style in traditional running shoes?

Simple is best some times well almost all the time -

before any specific advice could be given , you might want to look at your injury discription and be a lot more detailed

around the ankle could mean one or more of many things injured

 

Its the usual problem of different running techniques load different tissues differently (I blogged about that here).

Changing to forefoot strike changes the mechanics in the back (see this thread), but increases the load in the posterior and medial leg muscles - 6 of one and half a dozen of the other!

To fix his achilles problem, you have two options:
1. Reduce the load in the achilles --> than means heel striking! (is that a temporary option for him? --> then 2)
2. Increase the ability of the tendon to take that load --> reduce activity levels and then progressive load; eccentric loading programs etc