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Calf pain. Heavy trainer. What orthoses?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by podtiger, May 13, 2010.

  1. podtiger

    podtiger Active Member

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    Just have a query regarding a patient of mine.
    37 year old personal trainer who does spinning classes and running for boot camps regularly. Very fit.
    Getting calf pain over last couple of years in midpoint of lower leg. on and off. Sore after running for a 1km and doesn't get better. Nagging pain.

    Could have more flexiblity in calfmuscles. Hamstrings good flexibility.
    Does fair amount of stretching.

    Lower medial arches on weightbearing. Gait showing signs of being apropulsive. No sign of tendoachilles bowing but definite rearfoot varus in both feet. Good motion in all feet joints.

    Have prescribed more calf stretches. Is going to get physical therapy for both legs from physiotherapist. Rest from causing activities for 2 weeks. To wear Brooks beast runners for maximum support

    Orthoses prescribed- casts taken.

    My question is this. What orthoses design would best suit this particular person who trains so much?

  2. Hi Podtiger,

    1st you need to decided on what is causing the pain.
    is it mechanical overuse ie too much load
    something like exercise induced compartment syndrome.

    if it the 1st there are some more chances of conservative help if it the 2nd you may need to get some pressure testing on the superf- posterior compartment.

    ok so lets now discuss conservative tx.

    rest - the basics.
    Now if it´s mechancial overuse, think about the role of the Gastrocnemius and soleus muscles. The are loaded and return energy during dorsiflexion and plantarflexion of the ankle.

    They may have a small role to play in supination or pronation of the subtalar joint depending on the position of the STJ axis, but due to the short level arm to the subtalar joint will have little affect.

    ok with that ?

    so the most important part of your treatment will generally be the use of a heel lift, buy plantarflexing the ankle you will reduce the loads on the gastoc and soleus muscles.

    your device will affect the amount of pronation and supination which may help to releive the patient symptoms but the heel lift should do more, you can combine both if you want.

    hope that helps
  3. Just thought of something else.

    Appart from getting the patient to stop spinning for awhile- huge loads on Gastroc/sol. You should also suggest the patient gets someone to look at their position on the bike, seat height etc. These things can effect the load on the Gastro/sol alot.
  4. Zuse

    Zuse Active Member

    when i first read the post i thort of compartment syndrom! it does sound like it comming on after around a 1km run and if he has muscular calfs or even if he hasent it might be worth checking out!
    let us know what happens!
    Thank you!
  5. Graham

    Graham RIP

    A sagittal Plane faciltation device of course. :dizzy:
  6. Intersting, can you explain how this device would reduce the load on the gastroc/sol complex ? Cause I´m confused as Podtiger never said anything about a Fnhl .

    While having less dorsiflexion stiffness of the 1st MTP may make it easier for the Gastroc/sol complex to cause a plantarflexion moment, it would not be the 1st thing I would think of - heel lift ?

    Anything else ?
  7. RobinP

    RobinP Well-Known Member

    Have a read through this thread


    Some similarities in the case - might prove informative

  8. Graham

    Graham RIP

    Heel lift yes - this is a sagittal plane device!

    However, theoretically, feet on hard flat surfaces are sagittaly impaired due to delay or limited function of the first MPTJ. Failure to progress forward over this joint results in shorter stride, failure to fully extend the knee and hip and gradual shortening of the achilles/gastroc/sol. Also, with the requirement of an abductory twist into propulsion, assissted concentrically by the Gast/Sol the muscle is worked excessively, gets strong but short - theoretically.

    Could also be compartment syndrome but possibly as a result of the above - pehaps - maybe!:D
  9. Yes ,but I bet you a Kootenay pale ale that your were meaning a orthotic with cut out 1st. my favourate beer in the world after my 2.5 years living in Whistler BC.

    I would have said greater resistance to the plantarflexion moment at the ankle from Gastroc/sol contraction and left it at that, but the rest is something to think about.
  10. Graham

    Graham RIP

    Swing by. I have some in the fridge!
  11. Might take me awhile !! :drinks
  12. podcare

    podcare Active Member

    The cause is crucial. Keep in mind the Tib. Post. muscle. A patient of mine recently suffered what he described as calf pain.

    Further examination revealed inflammation and pain upon palpation of the calf along the line of Tib. Post. up the leg and near the origin of the tib post muscle. This patient found propulsion and running difficult (i.e. could not run for 200 metres without pain) and symptoms would flare up especially with side to side shuttle running activities.

    Our treatment involved ice, low dye taping, gentle calf stretches, forward running with low dye taping only, NO side to side stepping or side to side running for six weeks, deep soft tissue massage along line of tib post tendon, tib post strengthening exercises and orthoses to decrease pronation forces with medial heel skives.

    Reviewed this guy last week and he reports he feels 100% better. Has had his orthotics for 4 weeks. He can now run 6km without pain but I have advised him to hold off from any side to side shuttle running for a further two weeks.

    In conclusion the right orthotics work great in conjunction with other treatment if we know the cause of the calf pain. Tib Post muscle injury may be disguised as calf pain.


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