Case Study September 2016 – By Karl Lockett, Sports Podiatrist
Initial Consultation with Sports Podiatrist
A female middle distance runner aged 34 years, presented to the Sports Podiatrist with pain under the balls of both feet. She described a burning and tingling sensation when running. There was also pain for the few hours that followed each run. This active lady, reported to the Sports Podiatrist that the soreness in her feet had been going on for approximately 4 months. She runs 4 to 5 times a week and covers approximately 10 k’s each run, in around 45 minutes. She runs in an Asics DS racer and has done so for 6 months, but prior to this, she ran in a Brooks Ghost. She informs the Sports Podiatrist that she is suspicious that the change in style of running shoes is the cause of the problem, but she was advised to use the DS Racer by her physio. This lady enjoys good health otherwise and informs the Podiatrist that she has completed several half marathons over the last 6 – 7 years. She enjoys running and is reluctant to stop. 6 years ago, she saw a Sports Podiatrist for the treatment of shin splints, but since then she has had no foot and ankle problems. This patient lives and runs, in Coogee bay, which is known to be an area with lots of hills and inclines. She has always ran in this area and understands the additional load that comes with running such inclines.
This patient informs the Sports Podiatrist that the pain and burning in her feet feels like walking on hot pebbles. The area of concern is the metatarsal heads, and sits just behind the toes. The pain is equal in both the left and right feet. She has added an extra insole to the running shoes but to no avail. In anger, she reverted to the Brooks running shoes and did report some improvement but the tingling and burning persists.
Before seeing the Sports Podiatrist here at the clinic, she did see her physio again and he advised her to apply ice packs to the balls of the feet each evening, and to carry out exercises to strengthen the intrinsic foot muscles. While the cold packs gave temporary relief, the pain and burning persisted.
On a day to day basis this patient wears ballet flats and scuffs to and from the office and uses a dress shoe with a 3 inch heel height when at work.
The Sports Podiatrist Carries Out a Physical Assessment
With the patient standing in a relaxed position, the Sports Podiatrist took foot measurements including arch height and level of eversion at the heel. It is noted that this patient has a very high medial arch contour, measuring 35mm on the left and 33mm on the right. This foot type (sometimes referred to as the “Caveman foot” or Pes Cavus) bears excessive pressure under the heel and ball of foot, and receives minimal contact / support under the arch. This can lead to an overload of pressure in these 2 areas, resulting in the symptoms described above. Patient’s often describe a bruised feeling under the ball of the heel and forefoot.
On palpation of the areas of concern the patient reported pain. The level of pain seemed within normal range and the patient was not referred for imaging at this stage.
The Sports Podiatrist observed a very neutral foot type and measured zero inversion / eversion of the calcaneus (heel bone) during relaxed stance position.
Bio Mechanical Assessment by Sports Podiatrist
Markers were drawn on the feet and lower legs so that the Podiatrist could analyse this patient’s gait on a treadmill. Using digital software, her running style and foot function were captured, replayed and observed. This patient had a neutral foot type with minimal pronation. However, she had a bouncy gait, with a short stride, that encouraged forefoot strike. The Sports Podiatrist later informed this lady that there was an overload of pressure on the forefoot due to this foot placement. She had developed tight calf muscles too because of this running style and running on inclines.
Sports Podiatrist Treatment Plan
The Sports Podiatrist informed the patient that he was in agreeance with her suspicion that the change in running shoes was part of the problem. The Asics DS Racer is a minimal shoe with a very low heel drop compared to the Brooks Ghost and its mid sole is very soft and lightweight. Hence, the level of support is minimal which can lead to the foot “working harder” and bearing more pressure. The patient was asked to revert to the Ghost. The Ghost is a neutral shoe and still not as heavy as other running shoes on the market.
This lady was advised to use prescription orthotics in her running shoes in order to “fill in the gaps” under her arches, and therefore spread the pressure more evenly under her feet. This would reduce pressure under the balls of her feet and allow them to settle. She was advised that the orthotics were not “corrective” orthotics, as are prescribed to patient’s with flat feet and over pronation. Her orthotics would be more neutral. The Podiatrist also asked the patient to continue the use of ice packs under the painful areas of her feet. She was informed she could continue to run, and her activity would be reduced if improvement was slow.
Calf stretching was advised and would form an important part of her rehabilitation and recovery.
The Sports Podiatrist then went through a short talk on running style in order that the patient adopt a mid foot strike. This involved a slightly longer stride length.
This lady was booked in for a follow up after 8 weeks so that her progress could be monitored. However, she sent an email cancelling her appointment as she was happy with the rate of improvement and did not need further treatment.
Please note: The information in this case study is specific to the patient mentioned above. This case study should not be taken as general advice. If you have foot problems or running related injuries, you should seek the help of a Sports Podiatrist.