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Extensor Hallucis Longus Tendosynovitis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by echapman, Apr 17, 2011.

  1. echapman

    echapman Member

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    Sorry a dumb question

    I have caused myself a EHL Tendosynovitis - been resting (including 4 days in a cam walker - post a cortisone injection), NSAID's, ice etc

    any other suggestions ?

    I have had my orthotics re casted and should get new pair this week - major trigger hallux and massive plantar flexed 1st ray, HAV etc :confused: - not a very attractive pair of feet

    Any shoe pressure sets it off again :(

    More Cortisone ? further cam walker rest ? open shoe and no exercise for the rest of my life :(

    It was caused with running - up and down hills - Good fitting shoes but increase in activity - history of patella tendonitis and shoulder tendon issue - grrrrrrr all took years to resolve so any help for a poor podiatrist would be great - treating yourself and becoming a nightmare patient never good :(

    cheers :confused
  2. Hi How long ago did the incident occur ?

    What design features have you built into your new device ?

    Where along the EHL is it painful ?

    if it painful above the 1st MTP joint any dorsal lipping ? if so have had an xray ?

    But yes if the camwalker reduces the pain longer in it , but more information required.
  3. HansMassage

    HansMassage Active Member

    Interesting if past history of shoulder and knee are symptoms of same cause.
    My specialty is posture distortion. Many cases of repetitive use injury trace to antalgic posture stress. The swing of the arm is compromised by holding the arm to balance the center of gravity while avoiding weight on a compromised joint. This could be any spinal segment or lower extremity joint.
    Likewise the placement of the foot is similarly compromised when walking and running. This usually results in uneven use of one of the vastus muscles causing uneven strain across the patella.
    If the head is off center this will be balanced by the position of the big toe. Thus an indication of current condition.
    I have been working on documenting these patterns. I have the foot done at

    Hans Albert Quistorff, LMP
    Antalgic Posture Pain Specialist
  4. echapman

    echapman Member

    Hey Mike and Hans
    sorry for leaving out a lot of detail i was posting from my iphone and it was frustrating me to say the least.

    The pain started about 6 weeks ago post running down the fire trail next to the 1000 steps if you know them. - actually did it twice that day ! In good fitting realatively new (1 mth old) ascis

    I am a fit 34 year old - previous tendon issues - shoulder sadly due to a patient sitting on a chair as i went to move it. Knee petalla tendonitis was a running injury too - resulted in distal pole of patella surgical removal as well as discetion of fat pad and patella tendon - yep rather radical ! Discovered after 3 years of hell with it that complete removal of fructose (yep crazy i know) from my diet was the only thing that resolved it. I did everything possible prior to surgery including buying a treating chair with hand control :)

    As for my new orthotics - 1st ray cut out mod root, xt fibre relative neutral as a slightly cavoid foot type (used to be a lot worse prior to years of running) any further control always caused peroneal issues.

    I have had a x-ray which was normal - on examination i have a dorsal lump - but xray doesn't show any spurs / overlapping etc - just a result of my cavoid foot type.

    The pain is right in the middle of the tendon as it crosses the mid foot - only a 2 cm area - no pain at origin or insertion. No pain at the MTPJ with tendon do occasionally get pain in the actual HAV.

    Femoral torsion on that leg too with slight met adductus in both feet.

    A biomecanical mess !

    I do see a osteopath for general mantience every month and have a 1.5 hour massage monthly too - generally no other postural symptoms if i do regualar weights at the gym.

    I really want to get back to exercise ASAP but wearing any inclosed shoe right now a issue. Hmm back for another cortisone injection ? longer cam walker time ? :(

    Hope you both have had a great Easter
    Happy to answer any further questions

  5. Hi Emma it was nice except the Pollen explosion over here.

    so pain over midfoot - 2 cm area worse on wearing shoes right ?

    Sounds like compression problem - get some runners on and change your lacing system so the compression forces from the shoe is much less over the area see what happens.

    ps are you icing the area ?
  6. echapman

    echapman Member

    Hey Mike
    yes i have changed the lacing in my sneakers - locking laces and missing the x in the mid foot region - has made minimal difference - feeling rather sorry for myself at the moment - it really annoying me - anything annoys it - only been strolling walking over the break - frustrated !

    I basically have been only wearing mary jane style shoes for the last month - hence no pressure on the area.

    Yep i have been icing, and plantar strapping occasionally to stop excessive dorsi flextion of my trigger hallux.

    only been 4 weeks since cortisone injection - so not really wanting another one so soon .....


    any other suggesions ???
  7. Maybe try taking some of the load off it with a cluffy wedge - pre load the hallux so the EHL has less work to do added with you normal device may help. ? maybe also try a device without a 1st ray cut out. I´ve never used them don´t see the point ( another thread) just ideas ??

    maybe this instability by reduced surface area is leading to EHL over use.

    always hard treating yourself and internet advice and all maybe hit a colleague up for an assessment ?

    Camwalker if it reduces the pain longer say 2 weeks ?

  8. HansMassage

    HansMassage Active Member

    "I have had a x-ray which was normal - on examination i have a dorsal lump - but xray doesn't show any spurs / overlapping etc - just a result of my cavoid foot type."
    By dorsal lump do you mean an increased kyphosis? Is it located high, C7/T1 or low T11/12 or both?
    It would be very interesting to work with you but Australia is a long way from the Pacific NW US. You could have your massage therapist contact me through http://reflexposturology.weebly.com/ Palpation findings would be more in common between us.
    I believe my prescription would be to lay on your back and practice running by stretching a body ball with your heels. May sound strange but I have found that by digging your heels into a body ball and pushing with one while pulling with the other it has the reverse effect of a stair stepper in that it strengthens the reflexes for lifting the legs while running. Use your elbows to maintain balance and it will reduce the kyphosis. If your arms internally rotate [thumbs point toward thigh instead of straight ahead your massage therapist may need to release the subscapilaris.

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