Clifton Bradeley Biomechanics and Podiatry Consultation

This 25 year old, 15 stone male client came into me with a recurrent right hip problem, lower back pain which he had suffered with since childhood and right leg pain below the knee on the outer side of his leg. Although his back had always been a problem during standing on hard flat surfaces, his right hip and leg pain only troubled him during running. The more he did the worse his leg became and he was limited to about 15-20 miles a week. He had been successfully accepted into the 2004 London marathon and was recommended to us by a well known physiotherapist.

The assessment took approximately three hours and was very detailed.
We started by looking at the mechanics of his feet in detail and working up through the knees, hips joints, pelvis and lower back.. It quickly became apparent that his problem was not related to foot function alone because his feet were quite efficient, although his right foot was pronating a little more than his left. I also noticed that his Nike Pegasus didn’t support his body weight during running as they were very soft and excessivel worn. As I worked though the assessment he appeared to be fitting into all the normal ranges of motion at his joints, until I came to the leg length measurements. I routinely carry out eight different ways of assessing leg length both on the couch and weight bearing and usng our special technology and software.

'Carrying out eight different ways of measuring leg length may seem a lot but after fifteen years as a running biomechanics specialist I now know that real/anatomical or apparent/functional leg length discrepancy is a very common cause of running injuries and your assessment has to be as accurate as possible’.

I concluded from the measurements that this runner has a 1.5cm difference in leg length, his right being the longest. It was a real bony difference and responsible for all of his running injuries and postural adaptation throughout his body. His pelvis was high on the right side which had misaligned his lumbar vertebrae in the frontal plane causing pain and a scoliotic curve of his spine to his left, the short side. In stance and gait the high right pelvis had increased the varus (inverted) angle of his right femur in relation to his left leg and this was causing tightness of the iliotibial band on the out side of the upper leg. This tightness was pressing on a bursa under the attachment of the Iliotibial band to the Greater Trochanter of the femur creating Greater Trochanteric bursitis. The pain on the outside of his right lower leg was being caused by spasm in the Peroneus Longus muscles which being over loaded during the excessive pronation of the right foot.

As a treatment program I took a non-weight bearing cast of his feet to have made a pair of bespoke functional orthoses made from carbon fibre to control his body weight. The cast was taken non-weight bearing so that I could cast the feet in the same neutral (unpronated) position. I ask for the left orthotic to be raised by 7mm and both devices to have a rearfoot medial (inverted) post of 4 degrees which, I felt was his best functioning position. I a a strong believer in not putting the whole difference o a heel raise alowing the orthotic to work and allowing the body to naturally help along side the biomechanical correction.

I also recommended that he changed his running shoes to ASICS 2130, which I felt would support his body weight and hold the orthotic prescription efficiently. I also recommended that he had deep clinical massage for his tight Peroneus Longus muscles and his back mobilised at sacroiliac level. I called him a week after he had his orthotics and after the six month review this gentleman had a complete cessation of his symptoms and was on cause for the London Marathon. I normally review all my runners after 12 months also.

The assessment took approximately three hours and was very enjoyable for all concerned.

Case Study B

This 28 year old, 8 stone lady came into me after starting to run three months earlier. She was training for her first half marathon having got the running bug whilst completing a ‘Run for Life’ event raising money for cancer research. Before the injury she was training on the roads and had stepped her mileage up from 10 miles a week to 40 miles a week in the space of three weeks.

She presented with pain in both lower legs on the inside of her shin bones radiating approximately six inches above her ankle. She explained how when she first set out on a run the legs would be fine but after only five minutes the pain gradually came on and within minutes got so severe that she had to stop and walk home. Rest and physiotherapy helped but as soon as she started training again the injury returned as severe as ever.

I carried out a full biomechanical assessment and gait analysis and found her to be reasonably efficient but a little weak generally in her legs. The major finding was the axis of motion of her subtalar joint in both feet were medialy deviated creating excessive frontal plane inversion and eversion of her heels. This resulted in excessive pronation (rolling-in) in both feet during which the heels evert excessively. Her feet were generally rather weak and hyper-mobile collapsing under the influence of her body weight.

I diagnosed her injury as bilateral Medial Tibial Stress Syndrome (shin splints). The Tibialis Posterior muscles is attached along the medial (inner) side of the tibia and inserts on top of the medial arch of the foot. If this muscle is weak and the foot is excessive pronating the medial arch collapses resulting in pain alng the inside of the shin bone. This causes micro vascular bleeding along the periosteum where Tibialis Posterior attaches to the tibia. The area would be sore to touch and slightly swollen.

She was dispensed a pair of bespoke functional orthoses made from a non-weight bearing cast of her feet and advised to buy a pair of ASICS Cumulus runnng shoes, which offered cushioning and some stability for her new running orthotics. She was also advised to train more often on off road surfaces weather and time of year permitting and to carry a strength exercise for Tibialis Posterior. I also rescheduled her training program and put her in touch with the road running section of Stoke AC. She is now injury free and progressing nicely.

Case Study C

This 10 stone, 45 year old man came into me with bilateral (both) knee pain and back pain during running. He had suffered with his knees as a younger man playing football and regularly had lower back fatigue if he sat for stood for long periods. He explained that shopping with his wife all day in the Trafford centre really hurt his back at the end of the day and as a result hated shopping.

He had the full and detailed biomechanical assessment and gait analysis suitable for any sport. I examined his training schedule and carried out a shoe consultation using several pairs of his old shoes. His shoes showed the classic wear and tear marks of a severe over pronator, worn on the inner side of the heel and ball of the foot. It quickly became apparent that he was an excessive pronator at both his midtarsal and subtalar joints of his feet. His heels were everting to 8 degrees during stance and gait, which was causing the tbia in his leg to excessively internally rotate. The quadriceps muscles above his knees were rather weak because he had been out of sport for quite some time. The excessive internal rotation in his lower legs was causing the knees to excessively internally rotate and this was causing the patellae (Knee caps) to mal-track laterally (Outwards). This was being exacerbated by a weak Vastus medialis muscles, which would normally stabilize the patellae keeping it in the smooth patella-femoral articulation and the knee bends.

The excessive internal rotation at the knee was also causing the femurs to excessively internally rotate and this in turn anteriorly tilted the pelvis forwards. This has the effect of increasing the lumbar sacral angle at the base of the spine stretching various structures around the sacroiliac joint and lumbar vertebrae resulting in discomfort during running and long bouts of standing.

This man was wearing Asics 2120’s which I considered to be an excellent stability running shoe with moderate motion control features, but they were a little too wide for his feet allowing them to excessively pronate within the shoe. I prescribed him a pair of bespoke functional orthoses made from a non-weight bearing cast of his feet to use with his shoes. Asics are ideal for supporting orthoses and maintaining the prescription. I also suggested that he modify his training schedule y and strengthen his leg muscles. Once a running gets older than 35 years of age I would recommend doing general leg weights to replace some of the muscles strength lost by aging! (I know I’m going to get in trouble for this aging comment, but unfortunately it is true).

This man is now running steady miles pain free! He still hates shopping!

If any of the above sounds like your symptoms and biomechanics please feel free to call me for a chat any time. If I am busy which is highly likely I will always call you back.

Tel: 07793581402

Clifton Bradeley Sports Podiatrist