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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.

Ta!

Phil

 

Try something radical and get him to run with a wider base of gait:

See this thread: Use a wider base of gait for medial tibial stress syndrome

and this blog post I did: Shoe Wedging or Gait Retraining for Medial Tibial Stress Syndrome?

This thread is probably worth considering: Proximal influences in medial tibial stress syndrome

and all the other threads on MTSS.

 

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.

 

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?]

 

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?

Cheers
Phil

 

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...