Gentlemen,
I have enjoyed your blog tremendously. My inner mechanics geek motivated me to read all the blog posts, and go through the Youtube videos as well. Fascinating stuff.
My reason for writing, however is more desperate.
I have an athlete with a problem, and hope you might provide some guidance. She is experiencing what has been diagnosed as plantar fasciitis, with her pain on the medial side of her calcaneus - roughly 2 inches forward of her achilles, and about a half inch up. MRI was negative for a calcaneal fracture. She’s taken several months off, and had the site injected, but any return to running brings her pain back. It’s her mechanics that might catch your interest; she has what a doctor once referred to as ‘an Equinus Deformity", essentially running completely on her forefoot. She had heel contact when walking, but is completely on the balls of her feet when racing or training. Her injury history to this point has been minimal, with only a minor adductor issue for a day or two in her background. She has been told her options are injection (tried, helps for only a short time) or surgery. Humbly, is there anything we can do to help her overcome this? I am convinced there is an underlying mechanical issue, but her somewhat nontraditional running style leaves me with few ideas. Any suggestions would be worth their weight in gold.
Sincerely,
Girls XC/track coach
Dear Track Coach
Thank you for the Kudos and we are glad you have an “inner mechanics” geek as well .
We are sorry to hear about your athletes recalcitrant problem. It was astute observation on your part regarding her gait. Given the history you have provided, what has already been done, and the description of what you see, please understand that our opinion is limited, without the opportunity to examine her (which we would be glad to do; we have offices in the Chicago, IL suburbs and West of Denver, CO). Video would be helpful in the future as well, as we are not sure she has a true talipes equino varus foot or it is merely describing the attitude of the foot while running.
It sounds like she may have a rigid foot and a forefoot varus deformity. This would parlay with the “equinis” description.
A forefoot varus is when the forefoot to rearfoot relationship is such that the forefoot is inverted with respect to the rearfoot. This causes increased torque on the plantar fascia, as the forefoot lands on the outside of the foot and the medial side of the foot immediately descends: this must be controlled some how: either through flexion (downward motion) of the 1st metatarsal and cunieform (ie 1st Ray complex) provided adequate range of motion is available; the other scenario is that there IS NOT adequate range of motion of the 1st ray available and the knee collapses medially to bring the 1st ray down to the ground. A third possibility (most likely) is that it is a combination of the two.
The fix lies in the etiology: follow the mantra: skill, endurance, strength. Insuring the foot has adequate range of motion and is able to control it (skill), the appropriate endurance of the muscles to carry out the job (endurance) and the foot intrinsics have the cross sectional area needed to do the job (strength).
1. Does the athlete have a adequate foot tripod and are they able to keep all 3 legs of the tripod on the ground with the knee comfortably over the 2nd metatarsal? see a video here
2. does the athlete have enough muscular control of the lower extremity to ensure proper mechanics (foot intrinsics, knee motion, hip motion) ?
3. Is their running gait appropriate for their anatomy and any physical limitations? we have numerous posts covering many different gait scenarios on the blog, as well as on our youtube channel.
Again, without an exam, pictures or video, the exact diagnosis and fix is difficult. Thanks for the opportunity to respond.
The Gait Guys
