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Would appreciate some clear heads top help me think logically through a case.

The patient is me, significantly overweight (lets say obese 126kg - should be 100 or less for 1.88m tall). I have had a 6-12 month history of predominantly left side insertional achilles tendinopathy - have treated with heel drops to floor, heel raises etc which does help the heel pain on arising in morning. I do have tight gastroc/sol/hamstrings. I can now walk with no heel pain but i am finding when I attempt to walk at a fast rate, I develop considerable peroneal/tib ant cramping. To the point I have to stop. I do some calf stretching which provides some very short term relief, commence walking & the same cramping begins.

I need some help in mentally understanding from a mechanical point of view what is happening & then how to address.

 

Zac:

It is possible that your peroneal muscle pain/fatigue may be due to excessive external subtalar joint supination moments. Try adding a slight 3-6 mm heel lift along with an orthosis that has a lateral heel skive, valgus forefoot intrinsic balance and a valgus forefoot extension. This will increase the external subtalar joint pronation moments which will counteract the external subtalar joint supination moments that are likely causing your peroneal muscle symptoms.

I have just posted my January 1998 Precision Intricast newsletter on the "Forefoot Valgus Wedge Effect" on my Facebook page which may help you understand the effect of forefoot valgus wedges a little better.

https://www.facebook.com/kevinakirbydpm

 

Thanks Kevin. I have adjusted my orthotics as per your suggestion. I was trying to get my head around the effect of tight calves & cramping in tibialis anterior. When I palpate the lateral border of the tibial crest, it is very tender & "tight" feeling. With tight gastroc/soleus what is the mechanics of overuse of tib ant? It dorsiflexes the foot in swing phase & decelerates the forefoot after heel strike. What is the connection (if any) with the history of posterior heel pain)??

 

This is interesting to me because i am trying to document the effect of weight distribution and motion of the upper body on the feet and lower extremity. It is nice to have the description of a case in precise anatomical terms.

Your description matches what I have found in cases of a failure of right arm swing and avoidance of impinging motion at the L5 S1 joint. There are many other possibilities because one antalgic avoidance can lead to a cascade of other repetitive motion pains and avoidance.