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Middle distance spikes and orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Mar 13, 2006.

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    A talented 800m runner attended my clinic today. He has been suffering Right lateral knee- probably meniscus problems. Biomechanical revealed LLD with increased pronation on shorter (Right) side. He also has FNHL on this side. We are looking to manufacture FFO's for him but obviously also want to get him into the most suitable spikes. Can anyone recommend a good middle distance shoe that may accommodate this runners FFO's? I know, I know, but maybe some are deeper than others ;)
  2. PodAus

    PodAus Active Member

    As a retired National 800/1500m track athlete, if have some questions first.

    Is R lat knee pain exacebated by track work on bends (camber)?
    How much track work does he do? Is some of this work run in the opposite track direction? Does he run 1500m/5km track also? How much mileage on a road camber? Is this camber alternated?
    Will he be wearing the orthoses in his flats / mileage footware also?
    Has his mechanics been assessed on the track as opposed to just on a flat running surface?

    I'd be just as focussed upon the technical/training aspects of his stress, and identification/modification of his track work, which often can lead to R lat knee/ ITB overuse syndromes. Relative rest from the camber may be the key. Significant track running can also contribute to pelvic torsional syndromes which may present as a functional LLD. Are you attempting to address this LLD by 'balancing' with assymmetrical heel lifts?

    With an athlete I would confirm a D/Dx (are there any positive cartilage stress tests, or ITB Compression test?), and confirm the treatment goal before attempting functional adjustment (FFO's).

    The spike heel height is definitely relevant to windlass function / FHL., however spike brand should be virtually an afterthought until the answers to the above questions are clear in your mind.

  3. More than likely, the runner has iliotibial band syndrome. This often occurs on the more pronated foot and is the most common knee injury in higher mileage competetive runners. I would not recommend foot orthoses for track spikes since they are generally too heavy for racing, but you can make them for his training flats. For track spikes to reduce the mass of the shoe, I generally will try adding a medial heel and arch wedge of a couple layers of 1/8" adhesive felt to the insole of the shoe which seems to help in many cases. Also, if it is ITB syndrome, then start him on hip abductor strengthening, ITB stretches and twice daily (BID) icing therapy. And, by the way, I don't think that the finding of functional hallux limitus has any bearing on running injuries since less hallux dorsiflexion is required for normal running than for normal walking.
    Last edited: Mar 14, 2006
  4. PodAus

    PodAus Active Member

    Almost definitely ITB, which has its specific soft-tissue treatment regime (as Kevin stated). Of course it's very important to treat symptoms, however focus on the specific causitive factors whilst training (more specific than 'lots of running') - you then won't be trying to use brute force from an orthotic to battle unaddressed training issues.

    I use a flexible, extremely thin and lightweight carbon fibre shell that easily fits track spikes and cycling shoes, whilst providing significant and patient-perceivable 'support' (proprioception) for the athlete (I'd otherwise say 'control', however how does the patient determine control??). These orthotic shells really are the next generation of orthotic materials. They are REAL carbon fibre, not the usual glass/plastic composites passed off as carbon fibre (the reason why those type of composite materials still need to be as thick as thermoplastics).
  5. Thankyou for your comments and questions. He is to receive carbon fibre devices. I take from the lack of response to my original question that there is no specific model of spike which is better than another. He has positive Apleys compression and normal Ober's, which led me (and his physio) to think that the problem was meniscus.

    Question: how would the design of the orthoses be different if he had an ITB friction syndrome, compared to meniscal compression?
  6. I think it is better to rule out iliotibial band (ITB) syndrome by palpating the ITB at and around the lateral femoral epicondyle, and try flexing the knee to about 20-30 degrees while doing so, to see if this reproduces the pain. I don't find Ober's test very useful since there are too many false negatives. If it is the lateral meniscus, palpate along the lateral joint line of the knee to see if this where the patient feels the discomfort.

    I would not recommend just one track spike. It is best to send him shoe shopping at a quality running shoe store that carries a selection of spikes to see what fits best than to recommend only one shoe due to differences in lasts and "feels" of shoes.

    I have never used carbon fiber orthoses. How do you modify these orthoses if they are too wide for the shoe....a grinder? I am not too keen on inhaling carbon fiber into my lungs that would result from grinding carbon fiber.

    By the way, both injuries (the extremely common ITB syndrome and the very uncommon lateral meniscal injury in runners) should respond to an orthosis that causes increased subtalar supination moment. However, over varus correction with an orthosis will cause ITB syndrome in many cases.
  7. I've already done this too. I'm sorry guys, but in mine and a very experienced physio's opinion, this guy has meniscal problems. I could be wrong, but...

    In essence the device he would get for either of these two condition would not be a million miles away from each other. Since the 6 degree intrinsic (got to save space) varus rearfoot post should allow medial shift of CoP during initial contact, hopefully reducing compression forces at lateral knee, maybe limiting internal rotation of the shank. He has a plantarflexed 1st ray so the intrinsic valgus forefoot wedging should reduce the force couple created by the running limb varus as the heel unloads and the foot moves into propulsive phase- so if it is ITB this should help too. To accomodate the LLD, maybe there will be space for a small raise too ;)

    I'll let you know.
  8. The reason I am being persistent about ITB syndrome is that was my first running injury (at age 16) and continues to be one of the most common running injuries I treat at the knee (probably have seen over 200 of these in the last 10 years). As far as seeing a competetive runner with lateral meniscal pain, I have seen 0 in the last 10 years. Has the runner had previous knee trauma or knee surgery since otherwise, the medial meniscus is much more likely to get compression pathology in competitive runners.

    Now in low-quality runners, like those that have genu valgum deformity, I could see a lateral meniscal injury occurring. However, it is relatively rare to see a high quality runner have significant genu valgum deformity since nearly all of them have genu/tibial varum.

    Makes good sense that genu/tibial varum is the preferred anatomical alignment for runners since only with a genu varum deformity will there be a fairly straight line from the center of pressure on the plantar foot to the center of the knee joint to the center of the hip joint.....another little known fact within the podiatric and biomechanics professions...you read it first here. ;)
  9. hello,

    In answer to the original question, if it is useful I have found the saucony Ld spikes to be useful with orthoses as they have a sockliner which can be removed(other good brands are availiable).

    I also feel that for those who need any form of controll, a Ld spike would be better than an md spike as they tend to be too flexible in the midsole, even if the athlete competes at 800m/1500m.


    p.s. I have tried felt in running spikes... it rained!
  10. Many thanks Gareth. Very helpful.
  11. Saab

    Saab Member

    Hi Simon, i was following this blog and was wondering how did you go with your treatment plan regarding orthoses prescription?

    Did the knee pain dissapear or worsen?
    was the6 degrees rearfoot varus angle sufficient or too aggresive with teh carbon fiber?

    did you have to include other treatment modalities, ie "physio" work like ITB deep tissue work and /or Femoral abductor strengthening like Kevin suggested?


  12. Do you know what, nearly six years later..... I can't remember. Steve, look at the date of the thread.
  13. RobinP

    RobinP Well-Known Member

    Interesting to look at the language used.

    For the record, I have genu and tibial varum and have had partial lateral meniscectomy on both legs. Not an elite runner by any stretch but a national league hockey player
  14. Reviewing this thread six years on, why would an Apleys compression test give a false positive in association with ITB friction syndrome, i.e. why would the patient experience pain when performing a test designed to test the meniscus if the meniscus was uninjured and in actual fact the ITB was the injured tissue? I don't recall who the exact patient was so I can't review the notes. I do recall he didn't have an MRI, so I guess we'll never know for sure. I don't recall doing work on his ITB, since I didn't believe it was an ITB issue. Read the thread. However, if memory serves he ended up having a second pair of orthoses made up for his trainers, so I might have got something right.

    In what way is the language interesting, Robin?
  15. RobinP

    RobinP Well-Known Member

    Not that I have seen a case you have presented but I wonder if you would still describe this in the same way now.
    I have looked over early case presentations I made and although not necessarily being concious of changing how I describe things, there is a big change in my terminology eg 1st MPJ dorsiflexion stiffness as opposed to FnHL.
    Just interesting to see the evolution
  16. Looking at it again, all I really wanted was some ideas for middle distance spikes with a bit more room in 'em (i.e. any with removable sock-liners).

    I have over the years tried to avoid presenting cases and have tried also to avoid answering case requests here and on the old podiatry mailbase before this. I don't think you can ever provide detail enough to answer questions regarding diagnosis nor treatment via the internet. Pictures might help but these are rarely provided. Really, unless you have performed the tests you have no real idea. This is an interesting case in point, in this thread it is suggested that the patient may have problems with his iliotibial band, despite none of the respondents having seen the patient, nor examined him and in the presence of the minimal information provided by me. I had examined him along with an experienced physiotherapist, we had both drawn the same conclusion that there was a meniscal injury. I wasn't asking for a diagnosis, nor help with treatment per se, merely if anyone knew of a middle distance spike which might better accommodate the orthoses. Despite this, six years on a random has posted to this thread making the assumption that the injury was to the ITB :bang: None of us will ever really know. All we know is that "I think he got better" with my diagnosis of meniscal injury and orthoses designed and manufactured to the best of my ability at the time to treat this tissue.
  17. RobinP

    RobinP Well-Known Member

    I would have said that more than a few people started off by requesting help with cases and as time has progressed, have found themselves doing it less frequently, if at all. Increased knowledge and a good understanding of mechanical concepts allows analysis of most problems(if you are a tissue stress theorist)

    I think that presenting cases(especially for newcomers) is a useful experience on here. I know, on a personal level, that the process of presenting a case in a concise manner has led me to a solution without any external input. The organisation of thought about assessment, identification of problem and differential diagnoses then treating the pathology is extremely valuable in reaching ones own conclusion.

    I just like to see the change in language that has taken place over the years. Reading some early posts from top posters shows a real shift in the usage of mechanical terminology.

    All for the better in my opinion, despite what Dennis says
  18. Saab

    Saab Member

    Thanks Simon.

    SO its wasnt ITB?

    Just Joking!


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