Running Injury Advice

My Advice for Pes Cavus

Admin — Wed, 25 Apr 2012 00:07:12 +0000

The pes cavus or high arched foot is sometimes difficult to manage. It comes in several different forms. It may just be a high arched foot or no real consequence or it could be associated with supination at the ankle joint which can have more consequences. Often the two biggest problems with pes cavus is the different pressures under the foot that may cause symptoms and the tendency to supinate can cause a condition like peroneal tendonitis and increase the risk for an ankle sprain. The cavus foot type is also poor at absorbing shock and this shock can be transmitted up the body to the spine. Occasionally a pes cavus foot type is due to an underlying neurological problem and this needs to be checked out.

My advice for Pes Cavus:

Use running shoes with higher levels of shock absorption and good lateral stability
Strengthen the muscle on the outside of the leg
If you have problems with pressure under the foot, then you need insoles with cavities under the pressure areas to relieve the pressure.
Foot orthotics are also useful to relieve the pressure and stop the foot supinating
In the worse cases, surgery can be an option.

My Advice for Pose Running

Admin — Tue, 24 Apr 2012 03:48:01 +0000

Pose running is one of those many different running technique that are being widely promoted in the running community. The technique uses more of a forefoot strike, a shorter stride length and a more forward lean at the ankle rather than the waist. Many claims get made for it such as reduced injury rates, but there is no evidence for that and those clinicians who treat a lot of running injuries know that this is not the case. The biomechanical underpinnings of Pose running is somewhat flawed and the technique has been shown to be metabolically less efficient than other forms of running. There certainly is a lot of rhetoric and propaganda surrounding Pose running and those that promote it are certainly sensitive to criticism of it.

My Advice for Pose Running:

Pose running may be useful for some runners
Pose running increases the load on the Achilles tendon, inside leg muscles and the arch structures, so if you have any problems with these structures, then stay away from it.
Otherwise, if you are going to try it then make sure the transition is slow and gradual

For More:
Pose Running
Pose Running

My Advice for Peroneal Tendonitis

Admin — Mon, 23 Apr 2012 01:10:26 +0000

Peroneal tendonitis is an uncommon running injury, but can persist for a while when present. The peroneal muscles on the outside of the leg function to stabilise the foot on the ground and stop the foot from supinating or rolling out at the ankle joint. Peroneal tendonitis is more common in those with a foot that does supinate or has a higher arch profile. The symptoms tend to be in the tendons just about and/or just below the outer ankle bone (lateral malleolus). At first the symptoms are only present during running, but later progress to be present when walking as well and start to interfere with the running.

My Advice for peroneal tendonitis:

Reduce running activities to a level that is tolerable and substitute other activities to maintain fitness
Use ICE after running
Use some sort of lateral build up in the running to pronate the foot more, so that the peroneal muscles do not have to work so hard, or see a health professional experienced I this to do it. This can be used long term or gradually reduced over time as the tissues adapt.

References:
Peroneal Tendonitis | Peroneal Tendonitis | Peroneal Tendonitis | Peroneal Tendonitis

My Advice for Kohlers Disease

Admin — Thu, 29 Mar 2012 21:35:48 +0000

Kohler’s Disease is a problem with the tarsal navicular bone in young kids in which the vascular supply to the bone is disrupted. This leads to a softening of the bone and as the bone is one of the ‘pillar stones’ of the arch of the foot it lead to compression and deformity of the bone. Usually the child will complain of pain over the arch of the foot, bit given their age it can be difficult to get them to precisely localize the spot. There may be some slight swelling and it can cause the child to limp.

My Advice for Kohlers Disease:

This is serious. The cast is needed. Do not try and self-treat

Foot orthotics should be used long term after the cast has come off to keep the load of the arch of the foot and the navicular bone.

For More:
Kohlers disease

My Advice for Forefoot Varus

Admin — Sun, 18 Mar 2012 23:56:15 +0000

Forefoot varus is an uncommon biomechanical problem due to the alignment of the bone in the foot. When the heel bone is held vertical or in its neutral position, the medial or inside of the foot is off the ground. To get the foot to the ground, the foot has to overpronate in the rearfoot to bring it down to the ground. Forefoot varus is a bony or osseous problem. It often gets confused with a similar condition called forefoot supinatus, which is due to a soft tissue contracture. The difference between the two is important as a forefoot supinatus can be corrected, whereas forefoot varus cannot be (as it is a bony alignment problem).

My Advice for forefoot varus:

If you think you have forefoot varus, see an expert to make sure it is not a forefoot supinatus

If you really have a forefoot varus, then you need foot orthotics. No amount of stretching, strengthening or changing your running form will make it go away. The foot orthotic needs design features that bring the ground up to the foot under the medial forefoot

Resources:
Forefoot Varus | Forefoot Varus/Invertus/Supinatus | Posting for Forefoot Varus | Effects of Forefoot Varus Posting | Forefoot Varus

My Advice for Cracked Heels

Admin — Mon, 12 Mar 2012 00:49:25 +0000

This is not exactly a running injury, but it is surprising how many runners get cracks in the dry and hard skin that can develop around the heel. They can be painful. They occur when the fat pad under the heel expands out sideways and the skin is not supple enough or flexible enough to take the stress, so cracks. The crack in the hard skin, then pulls on the good skin below which may bleed and become painful. Every time you step on teh heel, teh crack opens, so healing can be difficult

My Advice for cracked heels:

Use a cream or emollient regularly to keep the skin supple and flexible

Use a file to remove the callus or dry and hard skin (a podiatrist can do this very skilfully)

When a crack does occur use tape to hold the edges together so that it can heel, then use the creams and file to prevent it happening again.

See a Podiatrist is this gets too difficult to manage

For more, see:
Cracked heels | Cracked Heels | Cracked Heels

My advice for Posterior Tibial Tendonitis

Admin — Sat, 25 Feb 2012 22:39:07 +0000

Posterior tibial tendonitis is a problem with the tendon on the inside of the ankle joint. The initial discomfort is usually felt either just above or just below the medial malleolus or inside ankle bone, sometimes extending down into the arch of the foot. There may be some swelling and more pain later as it progresses. The cause of posterior tibial tendonitis will be anything that overload the tendon. There are several foot types (eg a pronated foot) and running techniques (eg forefoot striking) that result in the posterior tibial muscle working harder.

My advice for posterior tibial tendonitis:

Restrict your activity levels to within tolerance (substitute some other activity like cycling or swimming). Use ICE and other modalities.
Get back to heel strike running to reduce the load on the tendon (you can worry about transitioning back to the forefoot later when it is all healed and the tissues have adapted to the higher load placed on them when forefoot striking)
Foot orthotics with the right design features are very effective at treating this problem. The foot orthotics has to be designed in such a way that they prevent the posterior tibial muscle from working so hard.

Long Term
After you are over the posterior tibial tendonitis, you can transition back to forefoot striking and away from foot orthotics very gradually and very slowly and very carefully so the tissues can adapt to the loads that are place on them. However, in some runners the loads causing the problem can be so high the tissues cannot adapt to the load. In that case, the heel striking and the foot orthotics need to be seen as long term options.

Resources:
26 yo with Chronic Posterior Tibial Tendonitis

My advice for ‘top of foot pain’

Admin — Sun, 12 Feb 2012 08:07:50 +0000

Top of foot pain is becoming a more common running injury with the trend to barefoot and minimalist running. The cause of the problem is due to the constant load on the forefoot dorsiflexing the forefoot on the rearfoot and trying to lower the arch. This results in a jamming of the joints and bones on the top of the arch causing the top of foot pain. Technically, this is referred to as dorsal midfoot interosseous compression syndrome.

My Advice if you have top of foot pain:

Restrict your activity levels to within tolerance (substitute some other activity like cycling or swimming)

Get back to heel strike running to reduce the load (you can worry about transitioning back to the forefoot later when it is all healed)

Use a heel raise (this helps lower the forefoot); also do even more stretching for the calf muscles as this contributes to the problem if they are tight.

Foot orthotics with the right design features are very effective at treating this problem. The foot orthotics has to be designed in such a way that they allow the forefoot to plantarflex relative to the rearfoot or they will not help

Long term:

You can transition back to forefoot striking and away from foot orthotics very gradually and very slowly and very carefully so the tissues can adapt to the loads. However, in some runners the loads causing the top of foot pain are so high the tissues cannot adapt to the load. In that case, the heel striking and the foot orthotics need to be seen as long term options.

For more information:
‘Top of foot pain’ Management in barefoot Runners

My Advice if you Overpronate

Admin — Thu, 29 Dec 2011 01:35:50 +0000

Overpronation is a term used to describe a foot that has rolled inwards at the ankle joint and is usually accompanied with a lowering of the arch of the foot. It is a term that is often overused and abused, especially in the running community. Feet that overpronate are not necessarily a problem. They are only a problem if the forces that are driving the overpronation is high. Many people have feet that overpronate and never have problems.

My advice if you overpronate:

Do not assume that it is a cause of the running injury you have.
Don’t listen to all the gurus who tell you to strengthen the muscles (weak muscles are a very uncommon cause of overpronation). That does not mean you should not do exercises, as they are probably beneficial.
Get proper advice re the most appropriate running shoe.
If overpronation is the problem, then foot orthotics are always the best short term solution. They will lower the force (is they are prescribed correctly) and allow you to get over the injury. As to if you need them longer term, then that will depend on the exact causes of the problem and just how much the overpronation contributed to the injury. Only an expert can determine than
Don’t listen to the online gurus with a blog and no qualifications and no experience in treating running injuries

For more see:
Overpronation in runners

My Advice for Nail Laser Treatment

Admin — Wed, 20 Apr 2011 03:32:40 +0000

Fungal infections of the toenails in runners are common. The fungus thrives in the wet and damp environment of the shoe, and this is especially true in runners as they subject the toenails to so much trauma. The treatment for this is prolonged with the use of either oral or topical medications. The chance of the infection happening again after (or during!) treatment is high doe to that environment inside the shoe. Recently there has been a lot of hype surrounding the use of nail laser treatment. This is a one off treatment.

My advice for nail laser treatment:

The FDA has approved it as being safe (that does not mean it works)
There are no independent clinical trials comparing it to a placebo or the current treatments
There are only the results from small uncontrolled outcome studies that have not been published for peer review done by the companies selling the laser device
The treatment is expensive and as it is still considered experimental, the insurance companies in the US are not covering it

None of this means that it does not work. All this means is we do not know. All we have are the current unsupported claims by those with a vested financial interest.

My advice: You need to make your own mind up on this one.

For more, see:
Nail Laser Treatment