Case Study – Sports Podiatrist, Sydney – Treadmill Assessments

www.sydneypodiatrist.net.au –  Are a group of sports podiatrists, Sydney based, offering biomechanical assessments. They are located at number 2 Martin Place and specialise and sports podiatry.

Case Study – Lateral Foot Pain

A 32 year old male presents to the sports podiatrist, Sydney, NSW – complaining of foot pain of approximately 6 months. He reports a tight pain and a pulling sensation along the lateral aspect of his right foot that refers into the lateral shaft of his lower leg, and fibula. This gentleman is a keen runner, cyclist and swimmer. He has successfully completed over 10 triathlon events. He explains to the sports podiatrist that the pain along the outside of his foot becomes apparent after approximately 10 minutes of running. The pain is bearable and once the foot has warmed up and the circulation to the area has increased, he is able to continue running. However, after approximately 45 minutes of running the explains to the podiatrist that the pain becomes very sharp and starts to affect him much more. Although he does not stop running, he feels that he is altering his gait and changing his foot strike position slightly. This seems to be affecting his knee and hip on the same leg and he is becoming increasingly concerned. During cycling, he explains to the sports podiatrist that the pain comes on immediately. This is understandable considering the amount of ankle joint plantarflexion that takes place during cycling –  Which significantly increases load through the lateral side of the foot. The patient has become increasingly frustrated and has resorted to taking medication in an attempt to reduce pain and encourage healing. However, the relief from the medication has been insufficient and his foot pain persists. Naturally, he reports to the sports podiatrist that his foot pain is not present during swimming. Over the course of the last 6 months, this gentleman has been to see his GP three times and has also been to see another sports podiatrist, Sydney. He also saw a physiotherapist and a chiropractor. So far, no imaging has been taken and he has found no relief.

Physical Assessment by Sports Podiatrist, Sydney

The sports podiatrist carried out a thorough physical examination in order to diagnose. Firm pressure was applied to well known anatomical landmarks along the lateral aspect of the foot and ankle. This included but was not limited to, the peroneal muscle and tendons. The patient reported pain as pressure was applied to the peroneal tendon at its insertion onto the cuboid bone. This would indicate some pathology with the peroneus brevis tendon attachment. The long head of the peroneal tendon which wraps underneath the arch of the foot and inserts into the navicular was less symptomatic although pathology within this particular tendon could not be ruled out. The patient was informed that it was highly likely that he was suffering with peroneal tendonitis, but that an ultrasound scan would confirm this. To this end the patient was referred to imaging.

Follow Up Appointment with Sports Podiatrist, Sydney

5 days later the patient returned to the sports podiatrist, Sydney for a follow up appointment. The report from the imaging centre was conclusive. The patient was advised that he did in fact have a tendonitis of the peroneal brevis and longus tendons. A treatment plan was to be formulated in an attempt to resolve these conditions.

Biomechanical Assessment

The sports podiatry is carried out a biomechanical assessment in order to eliminate any underlying issues that could have contributed to these conditions. The patient was asked to walk and run on the treadmill, in his bare feet and in his regular running shoes. His gait cycle was recorded using digital software from the iPad and footage was replayed in slow motion while notes were taken. The podiatrist was able to determine a leg length discrepancy and a limited range of motion in the calf muscles. Both of these findings being likely contributors to the strain on the peroneal tendon. The patient had a relatively stable foot type and demonstrated only mild pronation through both subtalar joints. It was also evident that the patient was running in a fairly lightweight and minimal shoe which offered less support than he actually needed. While this patient did not need a heavy motion control / stability shoe, the podiatrist did recommend a particular running shoe that was slightly stronger and more suitable to his foot type. The podiatrist advised that he did not feel the need to prescribe orthotics.

Tendonitis Treatment

1:  The podiatrist demonstrated calf stretching techniques that were to be adopted by the patient.

2:  The patient was given a specific model of running shoe to purchase.

3:  The podiatrist crafted an in-shoe device using semi compressed felt which was designed to lift the cuboid and unload the peroneal tendon on the affected foot.

4:  Strapping was applied to the affected foot using rigid sports tape.

5:  Shockwave therapy was used to stimulate blood flow and encourage healing of the affected tendons.  2000 repetitions were applied at 8 HZ and 2.4 bar pressure. The treatment was well tolerated and the patient felt immediate pain relief.

The patient returned to see the sports podiatrist, Sydney for additional Shockwave therapy treatments at weekly intervals. 6 treatments were carried out in total and incremental improvement was noted at each weekly appointment. During this period the patient reduced his exercise program but did not cease activity completely. At the 6 week follow up appointment with the podiatrist the patient reported an approximate improvement of around 80%. He was advised that no further treatment would be required but that he should continue using the in shoe device and keep up the stretching program. He was advised to increase his training program as much as he was comfortable with, and to return to the podiatrist in four weeks. The patient did not return for his four week follow up, but did send an email through to reception, advising that he did not need the appointment because he was happy with progress.

Please note that the information contained in this case study is specific to one particular patient and should not be taken as general advice. If you have a chronic foot problem you should seek the help of a qualified sports podiatrist.

Treating practitioner – Karl Lockett, sports podiatrist, Sydney.

Date: 14^th Feb 2017