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Help please - Sore tendon in arch of foot

 

   


moulli

Dec 22, 09 1:10

Post #1 of 13 (12744 views)
Help please - Sore tendon in arch of foot Quote | Reply

The last few days a tendon in the arch of my foot has been getting progressively more sensitive. It's the big tendon that sort of runs down the middle of your foot / inside of the arch. It's most easily identified by arching up your toes and feeling the arch.

Anyway, I first noticed it late last week when walking around barefoot. It kind of felt like some more of the arch was touching the ground when I walked than usual. Now it's progressed so that it's noticeable when walking in shoes and throbbing a bit when sitting at my desk.

Does anyone have any ideas about what is happening and what I should do about it? Just rest? Does it mean that I'm running badly, bad shoes, too much? All of the above?

Bit more background... I've basically just been learning how to run and I think I've been going overboard on the whole forefoot thing...

Any help would be much appreciated. Thanks.


spiderwj

Dec 22, 09 1:26

Post #2 of 13 (12739 views)
Re: Help please - Sore tendon in arch of foot [moulli] [In reply to] Quote | Reply

My two cents would be to get a foam roller (either the dark grey hard one or the trigger point roller) and roll you calf (inside, center and outside many times). There's a good change something is pulling on the tendon. Then get a golf ball and roll it around under your foot for a while (I'll do this at my desk at work all the time). These are two cheap and easy ways to loosen up the tension and release the pressure on the tendon. I'm no PT, just a guy fighting his own running issues.

Web


rroof

Dec 22, 09 4:51

Post #3 of 13 (12729 views)
Re: Help please - Sore tendon in arch of foot [moulli] [In reply to] Quote | Reply

In the odd case you have been in a cave for a while, google or search for "plantar fasciitis" and do some reading. I do recommend the "low dye" taping method that you will come across at your likely stage. Best of luck.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


trikicks

Dec 24, 09 18:08

Post #4 of 13 (12652 views)
Re: Help please - Sore tendon in arch of foot [moulli] [In reply to] Quote | Reply

I'm having the exact same issue. To be a bit more precise than just flexing your toes, it seems to be when I flex my big toe. The large tendon or ligament that runs along the arch, which becomes prominent when you flex the big toe, is what is very sore. It started happening around October when I went through a gait analysis and began focusing on a forefoot/midfoot strike with high cadence, from being a heel striker forever. I've tried the foam roller, some e-stim and icing it. I switched from the Lunar Trainers I'd been running in all season back to an older pair of Brooks Adrenaline (so more midfoot/arch support) and that has seemed to help a bit at least while running. But the tendon or ligament is still sore and not close to 100%. I'm not totally clear on if this is the exact same symptom (that ligament connected to the big toe) as PF, but I am concerned. It's the preseason and while I don't want to stop all running, I also don't want to have something bad linger into the actual inseason training in a month.

Anyone?
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rroof

Dec 24, 09 18:34

Post #5 of 13 (12648 views)
Re: Help please - Sore tendon in arch of foot [trikicks] [In reply to] Quote | Reply

Dorslflexion of the great toe effects the Windlass mechanism (good googling material for you). There is a small chance you actually may have flexor hallucis longus tendonitis as well, but playing the odds ...


Introduction
The clinical condition known as plantar fasciitis is characterized by pain and inflammation secondary to strain on the intrinsic musculature and plantar fascia at their origin from the medial calcaneal tubercle. The classic physical examination finding is point tenderness at the anterior edge of the fascial attachment to the medial calcaneal tubercle. This usually coincides with a history of pain upon rising in the morning, pain after periods of non-weight bearing or pain after prolonged weight bearing. Several potential etiologies of heel pain exist which are beyond the scope of this paper. The primary etiology of heel pain relevant to this paper are biomechanical abnormalities of the foot which lead to increased strain on the tissues that originate from the medial calcaneal tubercle.
The plantar fascia, or aponeurosis, is composed of central, lateral, and medial bands that originate along the medial tubercle of the calcaneus. The plantar fascia courses anteriorly along the arch of the foot, where the fascia divides into slips which eventually insert into the sides of the proximal phalanx in each toe. At toe-off, hyperextension of the metatarsophalangeal joints results in tightening of the plantar fascia and assists with resupination of the foot. The plantar fascia functions through the windlass mechanism to depress the metatarsal heads and elevate and stabilize the longitudinal arch of the foot during gait. Therefore, with every step from heel rise to toe-off the plantar fascia is placed under tension.1 In some patients, the tension within in this structure can become debilitating.
Multiple treatments have been recommended with various degrees of success for plantar fasciitis. Conservative modalities used to treat plantar fasciitis have included heel pads, orthotics, padding, strapping, stretching, physical therapy, non-weight bearing, NSAID's, corticosteroid injections, etc. The majority of patients will improve or be fully relieved by nonsurgical treatment. However, even with appropriate treatment, plantar fasciitis may become chronic and recalcitrant in nature eventually leading to surgery. There is no definitive surgical treatment of recalcitrant plantar fasciitis that is without complications. Therefore, a continued search for an effective conservative modality useful in the treatment of plantar fasciitis exists. In today's healthcare environment there is a tendency towards active mobilization and rehabilitation. A review of recent literature has shown an increase use of aggressive stretching of the gastrosoleal complex for the treatment of plantar fasciitis.

Literature Review
Articles documenting the outcomes of nonoperative treatment of plantar fasciitis have for the most part shown excellent results.2-4 However, there is no panacea in the treatment of plantar fasciitis.
One of the easiest and cost effective conservative modalities in the treatment of this condition is stretching. It is well accepted that an important contributing factor of plantar fasciitis is equinus.5, 6 Tightness within the Achilles tendon and gastrosoleal complex results in compensatory increased dorsiflexion of the first metatarsophalangeal joint during gait. Dorsiflexion of the first metatarsophalangeal joint via the windlass effect stretches the plantar fascia at its insertion. If the foot fails to resupinate at toe-off, increased strain is placed on the plantar fascia due to the windlass effect. Equinus has also been linked to an increased amount of pronation of the foot which causes prolonged eversion of the calcaneus during gait resulting in pathologic stretching of the plantar fascia. Therefore, it would only make sense that decreasing the tightness within the triceps surae would eventually have a positive effect on the plantar heel pain.
Davis et al in a review of 105 patients with 132 symptomatic heels noted an 89.5% success rate of nonoperative treatment for plantar fasciitis. Their treatment protocol consisted of nonsteroidal anti-inflammatory medications, relative rest, viscoelastic heel cushions, calf muscle stretching exercises and occasionally, injections. The patients reviewed in this study indicated that the stretching program was the most helpful treatment prescribed.2
A prospective randomized trail of several nonoperative treatments of proximal plantar fasciitis revealed a 72% success rate in those patients who underwent stretching exercises only(control group).3 The stretching program utilized in this study effectively targeted both the gastrocnemius and the soleus muscles. Although the percent improvement of some of the other groups with additional foot support was higher, the degree of improvement with stretching alone is impressive. Other authors have also advocated stretching. 4,7-13
Several recent reports have shown excellent success with the use of tension night splints in the treatment of plantar fasciitis.8-13 Overall the success of night splints in the treatment of plantar fasciitis has ranged from approximately 80% to 90%.8-13 Night splints maintain a constant, consistent stretch on the Achilles tendon and plantar fascia. When you think about it, both night splints and stretching are attempting to accomplish the same net result utilizing different means.

Discussion
Stretching of tight soft tissues can be supported by the physical property of creep. Creep is plastic deformation in response to strain. Consistent stretching of the gastrosoleal complex applies an important strain to the tight posterior muscle/tendon group, which not only maintains functional length but also eventually provides a net gain in length due to soft tissue remodeling laws.14
These soft tissue adaptation laws are the reason that stretching is beneficial. Stretching the triceps surae over a period of time results in a decreased tightness within the gastrosoleal complex. This avoids the many deleterious effects of equinus during the gait cycle. In a large percentage of cases, pronation secondary to the equinus is at the root of chronic heel pain. With equinus, the foot attempts to compensate for the lack of ankle joint dorsiflexion just before heel lift, by subtalar and midtarsal joint pronation. During pronatory gait, every step leads to a unstable forefoot because of unlocking of the midtarsal joint.5 In an effort to compensate for this instability, greater intrinsic muscle activity is required to stabilize the foot, resulting in excessive stress on the intrinsic muscular origins from the calcaneus inferiorly and particularly the medial tubercle of the calcaneus, leading to inflammation.15 Pronation also results in abnormal and prolonged eversion of the calcaneus leading to flattening of the medial longitudinal arch which increases the strain within the plantar fascia.6 Continued strain and increased stress to the plantar fascia and intrinsic musculature leads to the enthesopathy. This is sometimes radiographically evidenced as an inferior calcaneal spur of various sizes. When the local subclinical irritation secondary to faulty biomechanics exceeds a certain point then inflammation and pain begin.
Many patients will try almost any conservative regimen in an effort to avoid surgery. The authors utilize an aggressive stretching program in the treatment of plantar fasciitis. A few positional modifications during stretching have added to our patients success. It is very important to avoid pronation during calf stretching because of the resultant compensatory mechanism of an unlocked midtarsal joint that destabilizes the foot decreasing the effectiveness of the stretch and possibly increasing the strain on the plantar fascia. Therefore, the authors have instructed their patients to stretch their calf muscles with a traditional wall stretch holding the foot in a slightly supinated position. Recently, a patented prefabricated device available on the market helps accomplish this position during stretching by utilizing the windlass mechanism (FootFlex Performance Stretching Device). This device dorsiflexes the hallux which places the plantar fascia under tension elevating the arch of the foot into a more supinated position. Stretching with foot in proper biomechanical alignment allows a more effective stretch of the gastrosoleal complex and at the same time also is gradually stretching the plantar fascia. This effectively stretches both the triceps surae and the plantar fascia at the same time. There is no study, to our knowledge, documenting the effectiveness of this modification of traditional stretching exercises. Success noted at this time is purely anecdotal. However, stretching has been shown to be helpful in reducing the symptomatology of plantar fasciitis, and, the authors believe an even higher percentage of success could be achieved with proper foot positioning during stretching. A prospective outcome study comparing the two different stretching modalities would help determine the efficacy of this type of stretching in the treatment of plantar fasciitis.

Summary
Recent literature has shown stretching to be an effective adjunctive therapy in the treatment of plantar fasciitis. A review of the literature and theories behind stretching are presented. A stretching program of the gastrocnemius and soleus should be considered a cornerstone of any effective treatment plan.
References
1. Hicks JH. The mechanics of the foot: the plantar aponeurosis and the arch. J Anat 88:
25-31, 1954.

2. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of non-operative treatment. Foot Ankle 15: 531-535, 1994.

3. Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davios W, Alvarez R, Brodsky J, Cooper P, Frey C, Herrick R, Myerson M, Sammarco J, Janecki C, Ross S, Bowman M, Smith R. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle 20: 214-221, 1999.

4. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle 15: 97-102, 1994.

5. Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot: Clinical Biomechanics, Vol. #2, Los Angeles, Clinical Biomechanics Corp, 1977, p 174.

6. Valmassay RL. Clinical Biomechanics of the Lower Extremities, St. Louis, Mosby Year-Book Inc., 1996, p 23,76.

7. Schepsis AA, Leach RE, Gorzyca J. Plantar fasciitis: etiology, treatment, surgical, and review of the literature. Clin Orthop 266: 185, 1991.

8. Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle 12: 135-137, 1991.

9. Pezzullo DJ. Using night splints in the treatment of plantar fasciitis in the athlete. J Sports Rehab 2: 287-297, 1993.

10. Ryan J. Use of posterior night splints in the treatment of plantar fasciitis. Am Fam Phys Vol.52, #3: 891-898, 1995.

11. Batt BE, Tanji JL, Skattum N. Plantar Fasciitis: A prospective randomized clinical trail of the tension night splint. Clin J Sports Med 6: 158-162, 1996.

12. Powell M, Post WR, Kenner J, Wearden S. Effective treatment of chronic plantar
fasciitis with dorsiflexion night splints: a crossover prospective randomized
outcome study. Foot Ankle 19(1): 10-18, 1998.

13. Jimenez AL, Goecker RM. Night splints: Conservative management of plantar
fasciitis. Biomechanics 4(9), 29 - 33, 1997.

14. Frank C, Ameil D, Woo SL-Y, Akeson W. Normal ligament properties and ligament healing. Clin Orthop 196: 15-25, 1985.

15. Forman WM, Green MA. The role of intrinsic musculature in the formation of inferior calcaneal exostosis. Clinics in Podiatric Medicine and Surgery Vol. 7, #2: 217-223, 1990.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


trikicks

Dec 24, 09 21:34

Post #6 of 13 (12612 views)
Re: Help please - Sore tendon in arch of foot [rroof] [In reply to] Quote | Reply

Wow, thanks. Lots of info. Thing is, I don't have any pain in the heel typical of PF, nor pain when waking up that is greater relative to another time of day. However when walking or running I feel it...for example more so in my work shoes, which have poorer arch support. Or as I mentioned, when running I feel it, though switching to a more supportive shoe helped. Is it common for someone with a weak arch that falls, to need more supportive shoes when switching to a forefoot type of strike? Maybe it is a period of adaption for my body and it will subside, but I'm being cautious so as to not ruin 2010.
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Gatorade EndurAlliance Ambassador


rroof

Dec 24, 09 21:43

Post #7 of 13 (12608 views)
Re: Help please - Sore tendon in arch of foot [trikicks] [In reply to] Quote | Reply

Yes, it is good to be cautious since your description is just about right for early plantar fasciitis. Many people don't have pain in the morning until further along (so to speak). I won't often see plantar fibrosis on an ultrasound for example at your "stage". The biggest hurdle most runners have with plantar fasciitis is rest (easy enough), but how long and when do you get back. And when you do get back ... and so on. Thankfully, if recognized early, it is often a self limited condition. But, a word of caution, as it can be quite debilitating as well.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


SteveP

Dec 24, 09 21:52

Post #8 of 13 (12607 views)
Re: Help please - Sore tendon in arch of foot [rroof] [In reply to] Quote | Reply

In Reply To:
In the odd case you have been in a cave for a while, google or search for "plantar fasciitis" and do some reading. I do recommend the "low dye" taping method that you will come across at your likely stage. Best of luck.

FWIW, I agree with plantar fasciitis (in your case, of the arch, rather than the more common location in the heel). I also agree with using the taping for these types of plantar fasciitis, at least in the more acute phases, since the pressure in the arch by an orthotic may not be completely tolerated. Start with tape (along with the other shotgun measures - stretching, icing, night splint, etc), then move to an orthotic (OTC may be OK) as tolerance allows. More here: http://www.permanente.net/...ges/c4189-62878.html
Steve Palladino
http://www.permanente.net/...tor/steve_palladino/
http://www.eteamz.com/...rt=24&id=4591042


trikicks

Dec 24, 09 22:11

Post #9 of 13 (12605 views)
Re: Help please - Sore tendon in arch of foot [SteveP] [In reply to] Quote | Reply

Thanks to you both. I guess it'll be worth not running and just cycling (computrainers) and swimming...that shouldn't make it worse, right? I read the aforementioned note as well as others, which note the firm carbon soles on cycling shoes generally won't cause it to get worse (no flex).

So...continue to stretch (which I do often including yoga), ice (already doing this as well) and rest it? From reading the link you posted Steve, looks like 3 ibuprofen 3xday for 10 days may help bring down the inflammation as well, so I'll add that. How long should I wait (as rroof mentioned) before resuming running? Ballpark, of course...
-------------
My Stupid Blog
Gatorade EndurAlliance Ambassador


SteveP

Dec 25, 09 8:10

Post #10 of 13 (12561 views)
Re: Help please - Sore tendon in arch of foot [trikicks] [In reply to] Quote | Reply

In Reply To:
How long should I wait (as rroof mentioned) before resuming running? Ballpark, of course...

Tough question. The safest answer would be once the area is no longer tender to finger pressure. Fortunately, if you are in the Northern Hemisphere, it is a bit easier to give a little more time to rest (than if you were, say, two months out from an event). A few further thoughts:
1) while laying off of running, you might try deep end pool running with a floatation vest - insanely boring, but you do replicate the neuromuscular patterning of running, and that may be of some benefit in forestalling some declines in your running
2) when you ultimately resume running, taping or orthotics are a must as you resume. Also continue the stretching. Icing may be of benefit after your run as well.
3) when you ultimately resume running, start with ridiculously simple goals for duration - test dose of running, check your response the next day, then proceed based on whether the plantar fascia is holding up or regressing
4) to facilitate #2, you might want to start your running on a treadmill - so you have more control over surface/canting/speed, and most importantly, duration. Hop off if you get any twinges.
5) When returning to the road or trail, be careful to avoid having your affected foot on the high side of a cant (it would be better to have it on the low side of the cant).
Steve Palladino
http://www.permanente.net/...tor/steve_palladino/
http://www.eteamz.com/...rt=24&id=4591042

(This post was edited by SteveP on Dec 25, 09 10:25)


sametime

Dec 25, 09 9:24

Post #11 of 13 (12548 views)
Re: Help please - Sore tendon in arch of foot [moulli] [In reply to] Quote | Reply

30-40 years of recurrent plantar fasciitis

Gone. Learned to run in 5 fingers and strengthened the muscles of my feet. When I wear shoes, absolute minimal design (and Newtons that get blamed on this post for everything from stress fractures to genital warts).

Also a thing of the past: itb pain, knee pain, back pain, shin splints.

Oh. I'm posting times not seen by me over the past 10 years after doubling my weekly mileage to 40-50 per week. My prior limits were from the litany of aches and pains noted above. My limit now is available time.


goallout

Dec 25, 09 9:57

Post #12 of 13 (12537 views)
Re: Help please - Sore tendon in arch of foot [moulli] [In reply to] Quote | Reply

that's you plantar fascia.


moulli

Jan 5, 10 1:50

Post #13 of 13 (12368 views)
Re: Help please - Sore tendon in arch of foot [rroof] [In reply to] Quote | Reply

Thanks very much to everyone who responded and apologies for the lateness of my thanks (my excuse is terrible internet issues (work has blocked this site (N0000!!!) and I have no home internet) and a long camping trip.

Relative rest has improved things and I know have an idea of wherever to go if it gets worse again.

Much thanks to everyone.

   
 
 
 



Number of races this season
If you're going to race an Ironman or 70.3, how many triathlons beyond this do you intend to do this season (discounting any IM or 70.3 Worlds you might qualify for)?
Zero
1
2
3 or more
Not racing IM or 70.3 in 2014
Don't do triathlons
Not racing anything this year
Retired from racing