Medial arch pain in runner

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I have a 65 year old female runner training for an event.

Her only problem is medial arch pain just below the left navicular. Tight calves, more pronation in left than right (mostly in Rearfoot)? I suspect it's a soft tissue injury - any ideas?

Thanks in anticipation, Podski1

 

Have you tried taping?

It sounds like it might be PT tendonitis?

 

Hi Podski

Umm there's not a lot of info to go by here...but is there a limb length difference (structural or functional)?

Is there "N spot" pain? It could be a navicular stress fracture if there is tenderness on palpation of the proximal dorsal aspect of the navicular...

Have you looked at the location of the STJ axis and taken into account how, for example, a medially deviated STJ axis can lead to increased tensile force through the posterior tibial tendon? Use the tissue stress theory! I have found since thinking more about STJ axis location and tissue stresses that this has helped my orthotic prescription greatly...

Just my two cents worth...

Regards

Donna

 

It sounds like PT insertional periostitis/enthesopathy.
That's my one cent's worth!
Cheers
Mahtay

 

Hi Podski1

Not enough information for diagnosis but relief of pain is highest agenda anyway.
Diagnostic padding or insoles to improve function will get you on track.
Meanwhile, I'm looking for triggers in calves and joint ROM's and quality for any blocks.

cheers
Shane

 

Hi

what about the shoe last?
Sometimes this type of problems can be benefited with straighter lasted shoes, allowing more room at midfoot.
A straight lasted shoe also helps.. reducing pronation..

 

Thanks to everyone who replied to my post.

With low dye strapping, icing, a stretching regime and some new supportive Asics Gel Empires, the problem seems to have subsided and patient is happily running pain free once again!

Thanks.

 

Paul,

Could you explain this further? I am under the impression that a straight last accomodates pronation and does nothing to correct it.

Thanks,
Nick

 

Hi

Usually a straight lasted shoe as more torsional rigidity, although its not the best way to prevent pronation it will resist, adding medial posts and the usual features that you find in straight lasted shoes (usually the only shoes straight lasted are Stability/Motion control runner's) and you will have a nice set of features to prevent pronation.

 

Running shoes with medial support are 'normally' straight lasted to accommodate the morphology of the foot-type 'normally' associated with this type of shoe.

 

Here's an interesting fact: despite the technical advances in running shoes over the last few decades, the prevalence of running related injuries has remained about the same. Think about it

 

Sorry Simon, but you last post has prompted me to ask this question.
(I hope you might be able shed some light especially as I read in one of your recent posts that you have been 'shadowing' in a running shop.)

In recent years running shoe manufacturers have de-coupled the heel to reduce eversion of the calcaneus (or its velocity) during initial contact.

I have always wondered what happens to this feature when foot/shoe is interfaced with an orthotic?

Would the use of an orthotic 'dumb' down this feature as these forces are now spread across the whole heel?

I know in mainland Europe some orthopaedic professionals construct orthotics without a significant heel cup to enable the de-coupled heel unit to reduce the initial velocity.



Does anyone have experience of this?

 

I spend part of my week working in a clinic which is attached to a running shop and the rest of my week in my own practice. I guess over the course of any one week between 50-75% of my patients are runners and are experiencing running related problems. Does this make me an expert? No, but I'll do my best to answer your questions. However, Simon Bartold may be better suited to answering these.

Firstly, de-coupled or segmented heels will only work if the runner is a rearfoot striker! Secondly, in the reviews I have read the manufactures claim that the de-coupled heel aids in shock absorption. I guess we might extrapolate from this that this increased cushioning will also result in reduced velocity, but I've not seen any of the manufactures promoting decoupled heels as eversion decelerators. Indeed, they all still seem to use the good old medial block in the midsole to limit the range of eversion, with a few exceptions - Nike Caesium being one of these- great for forefoot strikers with pronation problems BTW, but have a "funny feel" on your feet and no sockliner for some odd reason . Mizuno employ a wave plate with higher amplitude wave on the medial side than lateral in their supportive / control shoes, but this is basically just a medial block. A review of the literature reveals that cushioning levels in athletic footwear is a contentious issue. I've attached a nice little paper which explores this.


Further, as I have previously stated in other threads, are we sure we want to reduce pronation velocity? Visco-elastic materials loaded more rapidly become stiffer and are able to store more energy. Energy storeage and return is pretty useful in running.

I like Niggs thoughts on this that the interface layers between the foot and the ground surface act as filters- see attached paper.

Foot orthoses have been shown to decrease maximum rearfoot eversion velocity in runners (MacLean CL, Hamill J. Short and long-term influence of a custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, September 2005; Smith LS, Clarke TE, Hamill CL, Santopietro F. The effects of soft and semi-rigid orthoses upon rearfoot movement in running. J Am Podiatr Med Assoc 1986;76:227-232.) so why could the orthoses + shoes not have an additive effect?

Interestingly, the Asics Kinsei uses segmented cushion pads attached to a piece of plastic rather resembling an orthosis!

Not sure that forces are always spread across the whole heel. Look at where the segmented pads are situated on the heel of the shoe and think about the position the foot + orthotic + remainder of shoe at the time each of the pads are loaded. Isn't it the discreet position of the CoP which is ultimately responsible for determining the acceleration of joints due to GRF anyway?

How does changing heel cup height influence this?

 

Jonathan,

I couldn't work out why my post prompted you to ask the questions you asked, as actually your questions had little if anything to do with what I had said. So being a questioning soul I did a little homework and realised you are currently selling a piece of software for fitting the right running shoe.

So on your company website when you say: "Multiple studies have demonstrated that by prescribing the right running shoe such injuries will be reduced" this is obviously (on the surface) appears at odds with what I had said- hence the reflex jerk from you. Actually, there is a presumption that people are in the right running shoes, as you know, frequently they are not. However, do you have the references for the studies you note in your comments above please? Not trying to be funny, just trying to find out about this.

Sorry Jonathan, but reading you website has prompted me to request the views of other members on this software- from the list of messages written by Jonathan right click his name in the message header "Jonathan" and view his homepage. I'm not going to hyperlink to the website as I respect Jonathan for having not pushed this product down our throats since joining the list unlike certain others who have with theirs (I think- don't let me down Jonathan I haven't read all your previous posts!). He hasn't even linked his signature. Big respect Jonathan. Anyone have any comments on this?

 

Hi Simon

That’s fine - its certainly not a reflex reaction as I am afraid too old for that. I am actually (somewhat bizarrely) interested in understanding the dynamics of this more, with manufacturers working around one line of thinking and orthotists/podiartists around another - how do they interface?

There aren't many website that would be able to comment on such, hence why I read these posts (within sports/biomechanics) - you will see from my posts I have tried to help some contributors with my area of knowledge.

As for promoting my company - I don't.
We do however (have to be V careful here) sponsor the sports/biomechanics pages within podiarty-arena with direct google advertising (not generic google adwords).

Regarding the ‘multiple studies’ - I will get back to you on this (my technical lass is on holidays) – but I think it relates to studies on how running shoes cause injuries.

As you now know my contact details feel free to call - I don't sell wound dressings

 

Jonathan,

I didn't know you could sponsor podiatry arena with direct advertising. This and google ads- Craig must be making a fortune. In fact until you said this, I hadn't actually noticed your company being prostituted across my screen everytime I log in here. Or was I just being facetious with my previous posting? As for too old for knee jerk reactions? Seen them in all ages. How old is that "bottom block" fella? (I should try a good curry if I were him- might shift the blockage).

Anyway back to the plot, any ideas on how reducing the heel cup height of an orthosis allows the segmented outer-soles of trainers to decrease eversion velocity more effectively than deeper cupped orthoses as you intimated previously? BTW my Saucony Pro-grid triumph 4 with nicely segmented heel have a real firm, real deep heel-stiffener in them which is externally reinforced with some kind of plastic honeycombe. They are also as soft as a babies bottom with bags of cushioning. I love to wear them for work. I wouldn't dream of running in them- way too soft and nowhere near enough eversion control in them for me and I have a history of lateral ankle sprains! (It's the dynamic excursion that is key!!!)

Looking forward to reading the studies that show running shoes reduce injuries when your "lass" gets back and any references she may be able to offer stating that segmented heels reduce eversion velocity would also be useful.

Thanks in advance.

 

Okay Simon

1) Yes you can request a placement of adwords (under the google adwords umbrella - more expensive) - not directly sponsoring podiatry-arena - just placement and size, but they are know as sponsored links.

2) I do not think I mentioned 'heel cup height', I did however mentioned 'without a significant heel cup' - some clinics in Germany reduce the heel cup (of their orthoses) to just a soft shell to enable the shoes de-coupled heel unit to work more effectively - I would be interested if anyone has any experience with this.

3) Triumphs are cushioning/neutral shoes therefore aim to (kinda) do the opposite of a control shoe (which was in the Paulos discussion). However if it has a de-coupled heel unit - see attached - this area should be softer than the rest of the heel.

4) I am not sure manufacturer’s engage in evidence based research - I assume they would rather keep their IP to themselves or its marketing curry.

I am off to bed now -

 

Is my understanding that most manufacturers claim this design allow the heel of the shoe to move some how "Independently" from the rest of the shoe, slowing the foot between Heel Strike and Full forefoot load, attenuating shock, I never sow it as a serious pronation reduction feature.

But I found this from Adidas about their technology Formotion (formerly known as GCS):

http://www.press.adidas.com/en/DesktopDefault.aspx/tabid-35/27_read-1216/

Petty they don't mention the studies beyond their "Independent research"