Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Help with underlying cause of MTSS

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Phil Wells, Jan 21, 2014.

  1. Phil Wells

    Phil Wells Active Member

    Members do not see these Ads. Sign Up.
    Hi all

    I am after a bit of help with a patient.

    Long standing medial shin pain of 10 years which has never been successfully treated with anti-pronatory orthoses etc.
    His symptoms are text book MTSS/MTSF but he has the following mechanics -
    Very laterally deviated STjt with low supination resistance but otherwise a 'normal foot' - average arch height etc (Mild signs of FnHL in shoe and callus patterns).
    When running he has an exaggerated (For the speed he is running at) inverted and dorsiflexed foot position prior to heel contact (definite heel contact rather than midfoot striker) but rapidly everts/pronates the whole foot to achieve full contact.

    The question I have is should I apply lateral posting to reduce post tib activity secondary to the lat stjt axis (Some PT tendon tenderness on palpation) in walking/standing and medial posting when running to reduce pronatory moments?
    Or I am over thinking things?

    Any help gratefully received.


  2. Craig Payne

    Craig Payne Moderator

  3. Phil:

    Use an anti-pronation foot orthosis with a varus forefoot extension to reduce the valgus bending moment on the tibia due to his overly inverted foot strike and have him only run in the orthoses, not walk in them. Works wonders for 90% of patients with MTSS and/or MTSF.
  4. Griff

    Griff Moderator

    Hey Phil

    What are your thoughts on the possible reason/s behind his exaggerated inverted attitude prior to contact? Does he have a whopping tibial varum? What is he like proximally?

    Recently I've been taking a belt & braces approach - foot level intervention as Kevin suggests [to lower tibial bending moments] with concurrent proximal input to ensure gluteal recruitment characteristics are up to scratch functionally. Been dabbling a bit with base of gait width but too soon to know how useful it is in my hands [You had any success personally Craig?]
  5. Phil Wells

    Phil Wells Active Member

    Hi Ian

    Funnily enough I am seeing him today and this was going to be part of the approach.
    He doesn't have any tibial varum and has had work in the past on gluteal function from a physio - not sure what as he couldn't remember. His gait is quite short which makes me think there is some tightness proximally (maybe coming from his environment as he is a computer programer and very sedentary at work). Maybe hip flexor weakness/extensor tightness - any specific tips you can offer?

  6. Griff

    Griff Moderator

    I'm fortunate to work very closely to the Sports Physios who are far superior to me in their knowledge and management of such things so they very much take the steering wheel on the proximal stuff. Once we have identified various things which we believe to be important [Glute/Hamsting timing, contralateral pelvic drop etc] the rehab is tailored to the individual. With respect to gluteal activation we do seem to do a lot more functional/weightbearing drills now than I was first versed in several years back [favouring lateral band walks for NWB clams for example].

    I look after distally, they look after proximally, we share care on gait retraining [or involve running coach]... and hopefully Bob is your fathers brother...

Share This Page