Ankle, Tibial post pain

Discussion in 'Ask the Docs' started by Gil, Sep 9, 2013.

  1. Gil

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    Hello Docs, just need your advice on a recurent Ankle Pain.

    Background:
    I have low arch since my childhood. I started my transition 10 months ago. I'm able now to run 1 hour (10k) barefoot without calf pain during and after. I first made my transition with 0 drop shoes, but experienced pain on top of ankle malleolus after an interval training (this was a tendinitis or inflammation of tibial post tendon sheath). I had 8 chiro sessions with 4 radial schock waves sessions and recovered in 2 months. I changed my transition strategy and began to run barefoot thinking it was a smoother transition as my feet would tell me when it was time to end. I follow ken bob advice to have a light stride and bend my knees.

    Unfortunally, the same pain came again 2 months after. It's not a hard pain, but it's disturbing during running and after

    Questions:

    Does these TP tendon pain is linked to TP muscle stiffness or due to a weakness of TP muscle (low arch since childhood)?

    How can istrengthen my TP chain and continue running without shod+orthesis ?

    What is the best way to pass through this tendinitis and continue barefoot running when we have low arch?

    Thanks.:)
     
  2. Backfixer

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    Usually, if you have a flexible low arch, we recommend shod with foot orthotics and a straight lasted shoe or a more controlling shoe. This of course does not solve all the problems because you are likely built asymmetrically, have a short stride because of it, have a distorted core and have a hard ground impact. This is most likely why you have these problems.

    Typically, the myofascia which surrounds the muscles will shorten and tighten in the legs when a heavy impact is present which will make shins feel worse. Flat is generally inefficient, flat and toeing out (what I suspect) is more inefficient and because the muscle and the tendons of the tib anterior, posterior and peroneii, the usually suspects for shin pain take more of an indirect path, they do more work. Orthotics in theory help realign the feet into neutral (this is explained in much greater detail in my book Cheating Mother Nature available on Amazon.com). The problem is that if everything is tight, in the calves, gluts, hamstrings, ql, obliques and core, orthotics alone will help.

    Some believe everyone should be barefoot and will do best this way. In my experience, some will, some wont and others will have problems with shoes and other issues without, so we need to look past the feet at the core muscles and flexibility.

    Foam rolling may help (check out our video on this here http://www.youtube.com/watch?v=-BllSV77O08) but my suggestion is to ask your local running club about which chiropractor they use. That may be a good start. My book will give you a better understanding of these problems and how you can best find those to help you.

    I hope that helps
     
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  3. Barefoot TJ

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    Questions: Are the orthotics temporary or permanent? If the person can do all the work on their core muscles and flexibility, will they eventually be able to rid themselves of the orthotics?
     
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  4. Backfixer

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    Think of it this way, you are a building with a poor foundation. If I fix the foundation and then do work to the upper floors of the building, would I take the 2 x 4s that are leveling out the building out after I straightened the building out and did all that work. The body is the same way. Orthotics should be used to change the rules of the game. The game is my body mechanics are not great. The orthotics are designed to change the rules of the game for you, to make your body more efficient mechanically. Why would you want to remove something that has that kind of benefit, especially after you fix the upper body with perhaps chiropractic manipulation and myofascial release?

    This is BTW the reason my book was called cheating mother nature, which is what you need to do, cheat the system and orthotics and proper footwear tilt things markedly in your favor by creating symmetry.
     
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  5. Barefoot TJ

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    At that point, I would want to remove the orthotics because they tend to act like a crutch or a cast. If you continue to wear the cast, that body part will weaken and atrophy, and you will be reliant on a crutch for your entire life...or until you fix the foundation. Yes, I would remove the support beams and allow the body to do what God intended it to do...work.
     
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  6. migangelo

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    orthotics are a temporary solution. they relieve the pain at the moment but will force the body to adapt to the change in geometry and move the pain elsewhere. the body is smart and will do what it takes to keep the eyes level. that's all that matters to it. while you may cheat mother nature you can't outrun her.
     

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  7. Gil

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    Thanks for answers, but i'm a little bit confuse now...
    Should i better stop barefoot running and take my combo "control shoes+ortho" forever ... or
    continue barefoot (after recovering from tendinitis) with an ultra smooth transition or
    mix runs with shod and runs barefoot, expecting that one day it will be 100% barefoot?

    Do you guys completely succeeded your transition with low arch/ flat foot? how?
     
  8. migangelo

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    i have low, flat arches and have been running 3 years now bf. i use shoes as necessary. i have to wear shoes to work and they really affect the way i walk. i have some deeper issues that affect my gait, extended hip. i don't let it stop me. i roll my legs aggressively on a pvc pipe or baseball. i also have a great massage therapist for when i can't get out all the pain.

    everyone is born with flat feet. arches build during childhood. i'm not sure you'll get high arches but you can strengthen them. your arches are your tendons from your calves and feet. do some strengthening exercises to help with that. Janda short foot, calf raises, squats, pistols, dead lifts, and whatever else you like. i highly recommend you get this book. "trigger point self therapy manual" by Clare Davies. make sure you roll out your calves correctly. find the sore spot and hold it there until the tightness goes. sometimes i will kneel and use my body weight to drive my fist into the trigger points.

    it's a gradual process. you can't compare yourself to anyone else because we've all had different journeys. be patient, do your work and you can lead a more bf life.
     

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  9. Barefoot TJ

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    Well, this is the Ask the Docs :doctor: forum, I must admit, and the doc did respond with his recommendations. What you do with the info is up to you, but if you want to run and live a barefoot lifestyle, then perhaps after you have overcome injury through the doc's advice or other medical people's advice, try ridding yourself of the orthotics and big comfy shoes slowly, while exercising your feet and your legs (there are a lot of good suggestions for the types of exercises to do) to prepare you for running barefoot, and walk barefoot as much as possible.
     
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  10. jldeleon

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    Yes, being barefoot for activities other than running is crucial to building your arch strength as is VARIABLE terain. Hike trails barefoot! And it will take TIME to build that strength.You have to approach barefooting as if you are learning to walk/run again for the first time, EVER -because as far as your body's concerned, you are! Patience!
     

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  11. Sid

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    Interesting. I actually developed arches over about 1-2 years with barefoot running on asphalt. It wasn't an easy process, as I had to do a lot of stretching and massaging every day. However, improved arches didn't fixed my problems.

    Thanks to something that the Doc brought up in another discussion, I now realize that I have assymetries, too. They were evident with regular running shoes, causing some low back discomfort on one side. Barefoot/minshoes helped, though the problem came back with higher mileage and speed. I've found that running on sand is my preferred terrain, and I suspect that the unevenness of the sand reduces the effect of my assymetries and the sand forces me to slow me down. If I didn't have access to trails, I certainly might consider orthotics with minshoes at higher distances and faster speeds. Hopefully, it'll never come to that.
     
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  12. Dr. Mark

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    Gil,

    the Post Tib is the sling of the foot. you can do sets of heel raises and control the eccentric (lowering) component. light springy drills like jump rope and low height box jumps also good. there may be more going on and difficult to say much more over email. squats to work on ankle mobility are key to good movement too. Stay the course and run gently as you are doing. your feet teach you.
    Mark
     
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  13. Gil

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    Thanks Mark for your answer.

    Do you have any feedback or study on reconversion/ transition average time for people presenting low arches compared to others?
     
  14. Stig Walsh

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    Ok. I'm a Doctor, but not an MD, so take anything I say with a pinch of salt as I don't belong here as an authority;). I also have a low (ish) arch on my left foot and get Posterior Tibialis pains on that side. Despite having spent a great deal of my life barefoot it seems many of my stabilising muscles are not as good as I would have expected. That is not a reason to resort to correcting the problem through orthotics and shoes, it's a reason to get strengthening the weakness!

    I recently read Eric Orton's The Cool Impossible and I would recomend his foot/leg/hip strengthening exercises. Even just practicing standing on one forefoot for 30 seconds or longer has helped me - if the foundation and stabilising muscles are not up to the job, hitting them by natural running will find any weaknesses pretty quickly, especially on uneven terrain. Basically, running may not be enough on its own to build this strength. One thing we got wrong in the BFR movement is that running shoes themselves are less of a problem than the normal shoes we wear ona daily basis. 'Bouncy Castles' might cause problems of their own, but it's the normal shoes with their stiffness, support and heels (ANY heel) that makes our feet, legs and hips weak.
     

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