Basic biomechanics questions

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If I have a patient with quite visible tibial varum, normal foot pronation ( as in not excessive)....and the patient has persistent ITBS....

What sorts of things would you all be looking for in the way of orthotic prescription?

Hopefully as responses come in it will lead to better questions and a learning experience for me.

Thanks in advance

 

Hi Proud

I would look at the hips and knee 1st.

Does the person run + If so look at them walking and running, Ive found that a lot of people will have weak core and excessive hip movement.

So alot of the time I don´t look straight to the feet, Tx will involve stretching the ITB and related muscles of the hip, massage, ice, rest, NSIADS, core type training for pelvic stability. Look at there shoes if running in old shoes get the patient to buy new ones.

Also you will need to provide more info on the patient biomex profile to get better specific information on orthotic prescription.

 

Proud,

I'm interested to know what 'normal' foot pronation is? just kidding let's not go there

What effects do you think the varus tibia (and running limb varus) may have on foot kinematics? I actually agree with Mike - you have to think proximally too. Get them running and assess the frontal plane stability of their pelvis and what their hip abductor recruitment characteristics are like.

We need a bit more information really

Ian

 

One theory on the cause of Ilio tibial band syndrome (ITBS) (You should spell it out as not everyone uses the same abreviations. I was thinking irritable bowel syndrome, but couldn't come up with something for the extra "t".)
is that adduction of the lower extremity on the pelvis stretches the IT band or thinking in terms of moments an adduction moment on the lower extremity is resisted by tension in the IT band.

There is not much you can do at the level of the foot to decrease adduction moment on the lower extremity. What you can do is shift the center of pressure under the foot more laterally. A valgus forefoot or rearfoot wedge would theoretically do this. However, there is an increased risk of pronation related foot problems when you do this.

So, with this model (external adduction moment causes the problem) increasing the internal abduction moment by increasing strength in the hip abductors would also make a lot of sense.

There may be other models of increased stress with the ITBand.

regards,

Eric

 

Proud:

I am often amazed how the addition of a simple varus heel and medial longitudinal arch pad to the sockliner of the running shoe will often improve the symptoms in a patient such as you describe. Why don't you try this and see if it has any effect. Also, you may want to read this paper I wrote over a quarter century ago to make sure you aren't missing something in your history taking for your runner-patients.

Kirby KA, Valmassy RL: The runner-patient history: What to ask and why. JAPA, 73: 39-43, 1983.