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.

Looking for help with a field hockey player

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ann PT, Jan 14, 2010.

  1. Ann PT

    Ann PT Active Member


    Members do not see these Ads. Sign Up.
    I'm looking for thoughts and input anyone may have on an 18 y.o. field hockey player I saw today. She has a history of bilateral ant-lat. ankle "burning" which comes on within 5 minutes of running. Footwear (sneakers vs. cleats) does not make a difference and running surface does not make a significant difference. This started in the fall of 2008 and only occurs with running.

    She has seen three Orthopedists who have been unable to offer a diagnosis. Xrays and MRI are reportedly normal. She has had two courses of Physical Therapy and an Orthopedist recommended Footmaxx orthotics, none of which has helped her.

    She does have some mechanical issues but they are different on the right vs. left yet her symptom is the exact same on the right and left ankles. To simplify my findings for now, I will offer that she is somewhat supinated on the left through stance, has restricted eversion at her left subtalar joint, and decreased mobility at the left calc-cuboid joint. She also has a weak left soleus. She lacks some rotatory control at the left hip as evidenced by the medial deviation of her left knee when running. Her right side is essentially unremarkable yet she has the same symptom. Having very different mechanics right to left but the exact same symptom seems unusual to me if her pain is mechanical (which maybe it isn't?)

    Other miscellaneous information-she has bilateral hallux valgus and was born very premature (25 weeks) weighing only a pound and not walking until she was 2 1/2 years old.

    No one has been able to help this young woman to date. She is going to College in September and would like to play field hockey or at least be able to participate in intramural sports without pain.

    Any ideas are very much appreciated.

    Thank you!

    Ann
     
  2. Ann:

    In such cases, anatomical localization of symptoms is key....where exactly in the anterior lateral ankle is the pain?: deep in sinus tarsi, anterior talo-fibular ligament, extensor retinaculum, ankle joint capsule, inferior tibio-fibular ligament, etc.

    Due to this athlete getting the symptoms at 5 minutes into running, and if this is very consistent, then compression of the superficial peroneal nerve as it exits through the crural fascia in the distal-anterior-lateral leg is the most likely cause of the burning pain in the anterior-lateral ankle. Superficial peroneal nerve entrapment may cause anterior-lateral burning pain as the muscle compartment becomes more engorged with blood, the intracompartmental pressure increases and the nerve becomes compressed at it exits from deep to superficial through the crural fascia. To rule this out, have the patient come into the office ready to work out, have her run outside until the symptoms get very bad and then examine her for any decrease in sensitivity to the skin over the anterior-lateral ankle or increase in symptoms with palpation over the nerve exit point from the fascia. In some cases, (something similar to the mechanism behind chronic exertional compartment syndrome) the muscle will be found to be protruding through the fascia after exercise due to the pressure in the compartment. If this is the case, then have your friendly orthopedist do a fascial release around the nerve in the leg and her symptoms will be solved.

    Superficial peroneal nerve entrapment

    Hope this helps your patient enjoy field hockey again.
     
  3. Ann PT

    Ann PT Active Member

    Thank you Kevin. I was thinking nerve entrapment but was unable to reproduce her pain with palpation before or immediately after a run. I think I will try it again and be more specific with my palpation. Also I did not test sensation. I only palpated for pain and tested strength. Thank you for your input!

    Ann
     
  4. HansMassage

    HansMassage Active Member

    "Other miscellaneous information-she has bilateral hallux valgus and was born very premature (25 weeks) weighing only a pound and not walking until she was 2 1/2 years old."

    Is there a possibility that the bilateral hallux valgus is associated with a forward neck posture at C7/T1?
    Forward head posture has proved to be the most common cause of foot distortion in my clients.
    Hans Albert Quistorff, LMP
    Antalgic Posture Pain Specialist
     
  5. naoglesby

    naoglesby Welcome New Poster

    Could this have anything to do with wearing tight shin guards? These would place additional pressure on any lateral muscle group filling with blood due to running. Maybe her socks are too tight over the already tight shin guards. Just a suggestion.
     
Loading...

Share This Page