My advice for a plantar plate tear

The plantar plate is a strong ligament that is a thickening of the joint capsule that surround the metatasophalangeal joints in the ball of the foot. A strain or even a partial tear of that ligament is a reasonable common problem. The pain is typically under the metatarsophalangeal joint and also just distal to the joint on the bottom of the foot. It typically comes on slowly and gets progressively worse if steps are not taken to alleviate it. A somewhat weird description some with a plantar plate problem is that it feels as though a sock is bunched up under the ball of the foot, but when they check, its not. The diagnosis of a plantar plate tear is typically done by an expert clinician based on a series of clinical tests. Sometimes a diagnostic ultrasound is used to confirm the diagnosis.

My advice for a plantar plate tear

  • first of all reduce activity to levels that can be tolerates (and gradually increase as symptoms reduce)
  • use ice after exercise for the swelling and pain
  • use strapping to hold the toe down in a plantar flexed position and to limit dorsiflexion
  • use a rocker style or type shoe to help further prevent strain on the joint
  • if this does not give you a steady improvement in symptoms, then consult a podiatrist
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My advice if you have an abductory twist

An abductory twist is a common finding during a gait analysis and can be due to a number of different things and is commonly associated with ‘overpronation‘. It is a sudden abduction of whip of the heel medially or in the direction of abduction just as the heel comes of the ground. This video shows what it looks like:

More videos here.

Podiatrists tend to call this an abductory twist and physical therapists tend to call it a medial heel whip.

The causes is a foot that is pronating as the heel comes of the ground or a muscle weakness around the hips.

My advice if you have an abductory twist:
1. Get a gait analysis done by a clinician who is familiar with running
2. Find out the cause of the twist
3. Treat it.

More Information:

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My Advice on Toning Shoes

Toning or unstable shoes are a group of shoes that are supposed to increase the ‘tone up’ when walking or exercising in them. Due to the design of the shoe the muscles are working harder to overcome the unstable design. They also alter the gait and posture when wearing them as well. The marketing hype associated with these toning shoes has been recently brought down due to litigation and the lack of evidence that supported the claims being made. This does not mean that they do not have any use, it just means the science does not support the marketing hype.

My Advice for Toning Shoes:
I think all runners, especially if you are serious about your running would benefit from them. Shoes in the group include the MBT’s, Reebok Easytone and the Skechers Shape Ups. They are not for running, though some have tried! What they will do, is that if you wear them a few days a week casually, is that you use the muscles in a different way and change the posture in a different way. It is hard to argue against the potential that this might have in preventing injury. When exercising at a high level, it is often a good idea to mix it up. The variety loads and off loads different tissues.

For More on Toning Shoes:
Toning Shoes Today

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My Advice for Pes Cavus

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.

For More:
Pes Cavus | Pes Cavus | Pes Cavus Surgery | Orthotics and Pes Cavus | High Arch | Pes Cavus | High arch foot (pes cavus)

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My Advice for Pose Running

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

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My Advice for Peroneal Tendonitis

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.


Peroneal Tendonitis in Runners
Peroneal Tendonitis | Peroneal Tendonitis | Peroneal Tendonitis

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My Advice for Kohlers Disease

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

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My Advice for Forefoot Varus

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

Forefoot Varus | Forefoot Varus/Invertus/Supinatus | Posting for Forefoot Varus | Effects of Forefoot Varus Posting | Forefoot Varus | Forefoot Varus
The effect of forefoot varus on the hip and knee and the effect of the hip and knee on forefoot supinatus

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My Advice for Cracked Heels

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

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My advice for Posterior Tibial Tendonitis

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:

  1. Restrict your activity levels to within tolerance (substitute some other activity like cycling or swimming). Use ICE and other modalities.
  2. 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)
  3. 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.

26 yo with Chronic Posterior Tibial Tendonitis

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