Orthotic Specifications for anterior lateral tibial stress

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What Orthotic Specifications are people using for pain in the anterior lateral tibial region along the couse of tibialis anterior and also at level of anterior ankle in sheaths of ant. tib., ext. hall. longus and ext. dig. longus. No swelling or paresthesia present.

This lady is none sporty and has no tightness of posterior muscles. She atended a Physio who carried out ultrasound/icing but with little improvement. Patient will not take anti-inflammatory drugs. Apart from icing, and avoiding hard surfaces as much as possible would shock absorbing/ anti-pronatory orthotic devices be best prescription variables or has anyone any other suggestions to reduce stress on foot decelerators. Also would you recommend stretching and strengthing exercises for anterior muscle groups or would this cause further aggravation?

 

Need more info.

Do think it is strain of all the anterior compartment muscles? Is there a lot of extensor activity during the stance phase of gait? Any thoughts on why a hard floor exacerbates? Is there a forefoot slap soon after heel contact? Does it look like forefoot contact is delayed by muscle firing?

In college, every spring I would restart playing street hockey. Lots of quick starts on stops on hard pavement. I would get anterior shin pain that was my anterior tibial muscle. A little strengthening and it went away. Or was it just some time.

At heel strike, the anterior tibial muscle resists the plantar flexion moment from ground reaction force. A shoe with a posterior flare can increase the moment from ground reaction force, which would increase the strain on the anterior tibial tendon.

Eric

 

Lunge Test Result? - Might not be posterior muscle tightness

Robin

 

I'm with Eric, decrease plantarflexion moment. So shoe with a rounded heel in the sagittal plane (with a negative flare); shoe with de-coupled heel, reduce heel height; orthosis without rearfoot stabilizer- seem to recall from somewhere that extrinsic rearfoot posts increase plantarflexion moment(?) it's in my head from somewhere, but I can't remember where (getting old you know).

 

Makes sense - that would be an interesting read

 

It might have been from some data Jo Paton and I collected, looked at, but never published.?

It might have been from one of Rich Blake's papers- Blake and Ferguson????
Try these:
http://www.japmaonline.org/cgi/content/abstract/82/4/202
http://www.japmaonline.org/cgi/content/abstract/83/8/447

 

Although this patients pain is more specifically on the lateral tibia along the tibialis anterior muscle belly, I suspect ext. dig. longus and ext. hall. longus may be affected too, due to a duller pain as you move towards the fibula, tenderness along all the tendons at the front of the ankle and also appears to be alot of extensor activity from end of swing phase though to opposite toe off. Also patient does have slightly retracted toes. No foot slap.

Patient wears trainers majority of the time - asics, gel but having had a look at these trainers in the sports shop today I can see that they do not have a posterior heel flare. I tried a couple of pairs on with posterior flares and a couple without posterior flares and I can see what you mean. Very helpful info. Thanks.