Barefoot Adaptation & Forefoot/Rearfoot Varus

[Sam_S]

Hi Docs,



I have been told I have both a forefoot and rearfoot varus, resulting in overpronation during gait (think this would be mostly in heel-toe gait although to some extent also in toe-heel). Since age 14 (I am now 20), I have been wearing orthotics with a rearfoot wedge and heavy motion control shoes (Brooks Addiction). Despite this I was frequently injured in my career as a 400m sprinter (hamstrings particularly, growth related pathologies - i am 6"4, tibial stress fracture - whilst doing pre-season work mostly in my shoes/orthotics).

The final nail in the coffin was a 2nd metatarsal stress fracture which was the result of my own case of "Barefoot Running Exuberance Syndrome" -to coin a phrase. This was a result of replacing close to all of my non-track volume (100 & 200m intervals @ 70% max vel (~25-26km/hr) x 6-10km/week) with barefoot running almost from the get-go. Inappropriate management of the injury resulted in chronic synovitis in the 2nd TMT joint which still plagues me today. A return to shoes and orthotics, immobilisation and oral NSAIDs have made little dent in the problem; the only thing that has worked was a corticosteroid injection which worked for about 2-3weeks before the symptoms resumed. I was however, mostly barefoot in this time, and though I was not silly about it, did give in to the temptation to run short distances

 

[Dr. Mark]

 Sam,You learned the hard

Sam,

You learned the hard way from the BRES. There is a good preassessment on "are you ready to run barefoot". Balance on one leg, calf and plantar fascia mobility, and big toe alignment/stability are key. it would be interesting to see if you have correct joint "mostability" to coin another phrase. this means strong in the right places and mobile in the right places.

for questions:

a) rearfoot and forefoot varus common and can contribute to overpronation. genetic vs maladaptive....my suspicion is more maladaptive and compensation. The podiatrists would know more here. I’m a family doc. static vs dynamic testing also important....what you are doing while running in the whole kinetic chain is what matters.

b) i think some remodeling of bone can occur if forces return to the right place. certainly contining incorrect forces worsen deformity. devices such as "Yoga Toes" and "Correct Toes" can get toes aligned better and keep them that way. strength and proper range of motion protects wht you have left. i have large toe arthritis and have had surgery. keeping feet strong now.

c)tough one on email....but slow running , foot strengthening and gradual progression should help you get there. finding a good musculosketal and gait evaluator will help too.



Best,



Dr. Mark

 

[Dr James Stoxen DC]

Hi Sam,

I hope that the following video can help you with your problem.

Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running

 

[kozz]

When they say "varus," do they tell you a specific joint, like knee or ankle, or do they just mean the angle of your feet before they hit the ground?

If it's the latter, I bet your tibial stress fracture was on the left, because tracks aggravate the situation through all those counter-clockwise turns.

I'd like to see a banked outdoor track... but I doubt the IAAF would allow it.