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Post tib insertion pain during marathon preparation

Discussion in 'Biomechanics, Sports and Foot orthoses' started by podesh, Mar 12, 2006.

  1. podesh

    podesh Active Member

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    Hi all, I'm running the marathon des sables in roughly 4 weeks. My training has been going ok, but recently had a little niggle around the navicular, which I am thinking is the posterior tibialis insertion point.

    I have been careful during training, as my legs flare up if I'm not. I already wear orthoses as excessively pronate, under normal conditions they work brilliantly, but I think this problem is due to carrying a 10kg bag and running on very hilly courses. I am stretching loads, but is there anything I can add to my shoe/orthotic to help take the strain off, in the short term. I have cut back on the miles and am in the gym on the cross trainer, but really need to get to the start without this pain!!

    Many thanks
  2. Craig Payne

    Craig Payne Moderator

    There may not be a lot more you can do as you have done it, except:

    1) Actvity modification for a few weeks (replace some running with water running or cycling)
    2) Re-evaulate the orthoses prescription (or get second opinion)
    3) Physiotherapy (esp soft tissue work)
  3. podesh

    podesh Active Member

    may have answered my own question!! Went to family party this afternoon, wore heels...no pain!!! so two inch heels in the sand dunes, instead of trainers???? may set a new trend!!

    Many thanks Craig for your reply.
  4. Even though I haven't seen the word "niggle" used to described posterior tibial insertional tendinitis (maybe this word isn't "American English"), your pain should be fairly easy to resolve, as long as it is not too severe.

    The idea here is that the increased demands of training for a marathon are causing excessive tensile stress on the posterior tibial (PT) tendon which is causing your "niggle". Due to its anatomical course in relation to the ankle joint, subtalar joint (STJ) and midtarsal joint (MTJ), the PT functions to cause an ankle joint plantarflexion moment, a STJ supination moment and a forefoot adduction and plantarflexion moment (i.e. relative to the rearfoot). To decrease the tensile stress on the PT tendon, the orthosis or shoe must be able to add increased external STJ supination moment and external forefoot plantarflexion and adduction moment to work better at reducing the internal STJ supination moment and internal forefoot plantarflexion and adduction moment caused by PT muscle contractile activity.

    In the hundreds of runners that I have treated with your same condition that have preexisting orthoses, I will try to add extra "pronation-controlling" features to the orthosis in order to make them less symptomatic. Probably the simplest way is to add a varus heel and medial arch pad of 1/8" adhesive felt either plantar or dorsal to the orthosis. This modification, in effect, increases the orthosis reaction force (ORF) plantar to the medial heel and medial longitudinal arch which will cause an increase in external STJ supination moment and an increase in external forefoot plantarflexion and adduction moment. This orthosis modification, along with 20 minutes of icing of the PT tendon/navicular both after you run and one more time during the day (20 min icing 2X/day), should probably be enough for you to complete your marathon training. A drawing of this modification is illustrated below from my November 1993 Precision Intricast Newsletter on "Temporary Foot Orthoses" (Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997, pp. 273-274).
  5. podesh

    podesh Active Member

    Many thanks Kevin for your help, will try that today. The race is roughly 150 miles, over 6 days in the Sahara, running with all your gear. Why I chose to do this I can't remember, but my main aim is to get to the start injury free!!! thanks again
  6. DaVinci

    DaVinci Well-Known Member

    ....maybe because it feels good when you stop :rolleyes:
  7. Sounds like fun. The longest run I did was a 42 miler during my junior year (at age 21) from Davis to Yuba City in 1978 (in about 5-6 hours). It was a spur-of-the-moment run (i.e. we decided the day before to do the run) with some other members of the UC Davis cross-country/track squad to celebrate the UCD graduation of one of our fellow runners whose family lived in Yuba City. The cool thing was the graduating UCD senior was also a Sikh and the 8 of us that completed the run with him all were treated to a great Indian banquet that his parents had prepared for all of us (they lived in Yuba City) after the run. In addition, they gave us a little tour inside their Sikh temple in Yuba City. Of course, after that very long run, I developed iliopsoas tendinitis and couldn't run for a month afterwards, but it was certainly a run I will never forget.

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