I am posting this thread in the hope someone can provide a logical explanation and solution.
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I treated an elite 3000m runner approximately 6 months ago for MTSS. He was training 5 times a week mixing 1 long run with 2 or 3 interval/speed sessions and competition once per week. He was predominently a midfoot to forefoot runnner and was training in brooks trance and racing in asics DS racers, he had a mild soft tissue equinus and RCSP of approx 7 degrees everted. Jacks test indicated poor windlass function, Functional hallux limitus. forefoot to rearfoot mechanics were normal. Slight forefoot abduction in RCSP
Treatement involved activity modification, taping (modified tib post taping) ice, massage and stretching. Initial results very positive so a flexible poly inverted wedge orthotic of 6 degrees inverted was prescribed with soft top cover and 3 mm heel raise. review at 4 weeks and all symptoms had resolved and the patient was training and competing pain free.
I reviewed him 6 months later where he stated a 100% resolve of the MTSS however he had started to develop abductor hallucis cramping during running. This was followed by significant pain (only with palption and not affecting normal activity) up to a week after strenuous running. It wasn't bothering him as much as it was just annoying and was the orthotic contributing to his discomfort. This coinicided with state competition and an increase in workload and i passed it off as overuse and to return if the problem didnt resolve with a reduction in workload.
Havent heard from my orignial patient but I had another recreational runner this week with the exact same symptomology following 3 months of inverted wedge orthoses. (Also functional hallux limitus)
Am I missing something here? Is there a significant biomechanical factor in play that I have missed? I was considering doing a first ray cut out to midshaft 1st met but only really doing this to try and improve windlass which already appears to be functioning fine. Orthotic contour is good and there is no overhang causing direct irritation of the belly of AH
Any thoughts?
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