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1199 Views 3 Replies Latest reply: Dec 28, 2013 3:18 PM by JamesJohnsonLMT
grizlybear Rookie 1 posts since
Nov 26, 2013
Currently Being Moderated

Nov 26, 2013 11:26 AM

Peroneal Injury, Need Advicr

Hey, I just wanted to see if anyone else has what I have or at least knows anything else on it. So in the July of 2012, a year and a half ago from now,the side of my foot, then my ankle, and then my lower leg started to hurt. Since then, I have been battling this pain, which I think is an arch collapse. No one knew what this could be except my chiropractor, contrary to what I expected inronically. He told me that my arch collapsed and is pulling on my peroneal tends in my foot and ankle, and the peroneal muscle in my leg. In short, from my knee down was, and sometimes still is, in pain. I needed to buy customly built orthotics to solve the arch and everything else needed to sort itself out. Amidst that, I lost a year of cross country and running. I either wasn't running or hardly running. It wasn't until this summer I started running full work outs, but now I'm wearing and ankle brace and calf sleeve to compensate. Is there anyone in the same boat, does anyone have solutions to how I train back to running my times again, and hopefully better. The year before my injury was my first time doing cross country and long distance track and I got a varsity position, but now I'm doing so much worse then before. I don't know what I'm asking for really, but is this normal, or am I not going about this right?

  • Haselsmasher Legend 520 posts since
    May 25, 2009
    Currently Being Moderated
    1. Nov 26, 2013 1:29 PM (in response to grizlybear)
    Peroneal Injury, Need Advicr

    Are you sure you mean the Peroneal Tendon / muscles?  The ones on the OUTSIDE of your calf and ankle?  I ask because, if your foot collapsed, that would cause (it seems to me) to have those things SHORTEN, not get pulled tighter.  Conversely, a collapsing arch will cause the muscles on the inside of your calf and ankkle - Posterior Tibialis muscle and tendon - to get longer.

     

    I think wearing a brace is not a good idea at all.  It just encourages the joint to become weaker.  (You're telling your brain it can use the brace for support - so those muscles go on vacation.  They don't have to work so hard.  Alternatively, if there is no brace, then the system knows it must take full responsibility, and as a result get stronger.

     

    Now that doesn't mean you just take the brace off.  You have to rehab and make the ankle strong.  I *strongly strongly strongly* recommend you go to a good PT.  And I think a good rule of thumb when determining if your PT is good or not is whether they assess your hip function.  If you go in with ankle pain and they ONLY focus on the ankle and calf then I would fire that PT and go look for another one.  You want someone that is checking your hips in addition to the rest of your leg/calf/ankle/foot.  Weak and poorly functioning hips can cause all sorts of issues down the chain.  I had chronic heel pain and my PT found a problem with my hips and the heel pain went away.  She did no "PT" on the heel.

     

    Lastly, I would stay away from orthotics for your "collapsed arch".  Orthotics, IMHO, are way over-prescribed.  Many many problems that conventional wisdom says need to be fixed with artificial support can instead by resolved if you put effort into proper function, strength, balance, etc.

     

    Good luck.

     

    Jim





    "Kick off your high heel sneakers, it's party time."

    -- From the song FM by Steely Dan

  • JJReth Rookie 6 posts since
    Jan 18, 2012
    Currently Being Moderated
    2. Nov 30, 2013 4:36 PM (in response to grizlybear)
    Re: Peroneal Injury, Need Advicr

    Arch collapse sounds possible and the peroneals would be a major player in that. Before bringing in something like orthotics, I would ask the big question of why? What is not functioning in your body that causes your arch to collapse? It tells me that you have some movement dysfunction, more than likely at your hips, and the peroneals are kicking into overdrive to compensate. I would look at the quadratus lumborum and your ability to hike your opposite hip up during load phase of gait. If your QL is off, which is very common, your peroneals may be stabilizing for the QL. Adding orthotics will provide a temporary short term remedy but create longer term issues. Primarily, as Jim above mentioned, weakened musculature in the lower leg and foot.

     

    I suggest finding a highly skilled movement therapist who can properly assess your movement quality. Find out what is not working and who is compensating. They can then offer a corrective strategy to release the problem muscles and strengthen what is weak. With a sound treatment strategy, you may see almost immediate changes in your arch.

     

     

    Jesse James

    www.tao-fit.com

  • JamesJohnsonLMT Legend 1,163 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Dec 28, 2013 3:18 PM (in response to grizlybear)
    Re: Peroneal Injury, Need Advicr

    What you are asking for is too much, too soon. If you lost a whole year of running due to an injury, you should expect to take at least that long to regain lost fitness. In other words, running full workouts during your recovery time was banking on fitness you no longer had, resulting in further injury, and another increase in recovery time.

     

    I agree with Jim that the Peroneal assertion, as stated, is suspect, but perhaps a misunderstanding on your part of what the chiropractor actually said. Peroneals (aka fibularis muscles) are, for the most part, pronating muscles, used to evert the foot. An overused Peroneal muscle could be tight or weak, but if tight, could force the Tibialis Posterior muscle to tire and collapse the arch, as Jim indicated, and the chiropractor probably meant to say. Tib P works in opposition to the Peroneals, and tends to relax from stress rather than tighten, leading to less support for the arch, stretching of the plantar fascia, alteration of the gait, and likely chronic pain for a runner. This is probably what JJR was referring to by "major player."

     

    I'm not sure what rehab was done for this injury, but you should not be running on a collapsed arch. Your coach needs to pay better attention to your physical fitness before allowing you to run, especially before running full workouts. That is not a good strategy for recovery, as you unfortunately found out. You may have pushed to remain on the team, but the primary professional responsibility is to safeguard your health. If you have not experienced a miracle recovery by now, please scrap the aggressive training.

     

    I think JJR is on to something when mentioning the contributions of the hips to compensation injuries, but the hip and core muscles themselves often compensate for structural problems in the leg and foot. My guess is that your feet are built to overpronate, and the shortness of your rise to success in running did not allow time for the rest of your body to adapt to this stress. The peroneals probably tightened, the hip muscles probably began to malfunction, and the Tib P probably released the arch in a cascade of doom for one ambitious runner.

     

    I've seen this before, in others as well as myself. Early in my aggressive running history, I developed similar pain, stiffness in the peroneals, and loss of loft to the arch of one foot, as measured by a local running store pro. Full recovery was a long way off, including 6 months of no running at all, and over a year to slowly regain, and eventually exceed, my earlier fitness. Patience was key, but I also began to study this stuff for a living. Measuring the bones in my "bad" foot, it was apparent that the structure forced some unhealthy adaptations, and like you, I paid a price in pain and loss of function. There was also a difference between the length of my legs, the "bad" one being shorter. While this can be an actual physical difference, it can also be due to an imbalance in hip muscle tone.

     

    Muscular problems can be circular in nature, defying our best efforts to find an original cause, but bone abnormalities are more permanent. It is likely the bones of your foot are similar to mine, and inherent instability requires more work on the part of your stabilizing muscles, as JJR mentioned regarding the hips. My money is on the foot as the original cause, but the effects get spread out like a game of whack-a-mole. Yes, you can treat your Peroneal muscles, jack up the arch with an orthotic, brace and wrap to improve stability, but the original cause of the problem will continue to precipitate it.

     

    When your foot hits the ground, the load is spread out across the arch when present, normally in order from lateral to medial during the pronation phase. What deepens the pronation phase to a dangerous level, is the need to direct the pressure of impact to the strongest part of the foot. This need increases roughly in inverse proportion to the ability of the rest of the foot to bear impact and/or weight. If during the propulsion phase, force is somehow shifted to weaker structures, the foot will be pronated to return to the strongest position, on the thicker 1st metatarsal of the foot. If the remaining metatarsals are arranged in such a way that pressure is evenly distributed among them, there is less need to deepen or remain in pronation. In my case, the first metarsal bone was too short in relation to the second, and pressure had to be shifted away from the less durable 2nd metatarsal during the propulsion phase, to the first. This action requires more work from the Peroneal muscles, and can tire the Tib P resulting in a relaxation of the arch, and further problems dealing with impact.

     

    Understanding this problem does not involve rocket science, and is logical and accessible to the average runner. It is rarely discussed in the medical approach to injuries, however, because rhere are so many resulting symptoms to distract from the root cause.

     

    My advice is to have your feet analyzed for their inherent stability, before attempting to subject them to the rigors of cross--country running. While some orthotics can be crafted to compensate for this type of structure, most custom orthotics mold to the foot as it is, doing nothing to improve upon the basic alignment, other than to raise the arch. Such orthotics perform more as a crutch, and do not restore normal action to the foot via the controlling muscles. Instead, the critical muscles can de-condition from not being used, making the problem worse after time, as Jim mentioned above.

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