Thursday, March 29, 2018

Flat Feet, Over-pronation, and Running

The following is not intended as medical advice. If you think you have similar issues, you really should see a doctor or physical therapist.


Ever since I was first fitted for running shoes, I've known that I over-pronated to some degree -- in other words, with each foot-strike on the ground, the inside of my ankle rolls inward, my arch flattens, and things don't line up like they are supposed to.

"Stability" shoes did the trick for me up to about 10 miles per week, but once I got beyond that, I had to jump to full-on "motion control" shoes, as I started to get posterior tibial tendon pain as the miles increased. Motion control shoes have a "medial post' built into inner base of the shoe to keep your ankle from rolling inward; but unfortunately, they have limited support for the actual arch. My motion control Brooks Beasts got me through 5 half marathons in the spring/summer of 2016; but since April 2017, I have struggled with more foot pain due to this overpronation.

As you can see in the following diagram, the posterior tibial tendon starts under the medial malleolus (inner ankle bone), and runs up the back side of the tibia. Overpronation and a flattening arch put extra strain on that tendon, leading to pain and inflammation.


A while back, my doctor had recommended looking into orthotic arch supports from a local "sports medicine" specialty store, so I finally decided to stop in and see them. Their recommendation was not expensive custom orthotics, but a good quality off-the-shelf insert that would provide some cushion and support. I'm still not quite back to full-on running yet, but just wearing the orthotics around feels so much better, and I find the inserts they recommended to have a very natural feeling arch for my foot. I just bought a second pair for my everyday shoes, so I don't have to worry about transferring sweaty insoles.

As I stated above, if you have pain in your foot, you should seek the advice of a medial professional (which I am not); but it doesn't hurt to do research online to at least narrow down where the pain might be coming from. Here's a great video that I found while searching YouTube -- Bob & Brad are great:


My pain is exactly where they stated it would be -- originating in the arch area, with greatest pain focused directly under the medial malleolus, and sometimes radiating up the tendon past my ankle. Here is a video showing their top treatments for this disorder -- it seems to support everything else I've read online, although this is very simplified. There's a full list of exercises you can do to strengthen this area.


Another option that I'm trying out is the use of KT Tape (Rock Tape is similar). While it doesn't really "treat" the issue, it can provide added support, and take strain off of the tendon. I've heard that it is best to have a professional apply the tape the first time, so you can see what it feels like, but of course YouTube has videos for doing it yourself. Actually, a professional applies it in the video, but they show you how to do it -- and it is an awkward procedure when applying it yourself.


I am in the process of combining the old "R.I.C.E." recovery treatment (Rest, Ice, Compression, Elevation), but am also incorporating some of the treatments mentioned by Bob & Brad. I still have not abandoned all hope of running my 10th half marathon, which is scheduled for April 21st (just over 3 weeks away). 

I realize that at some point I need to follow my own advice and go visit an actual physical therapist; but right now, this is where this stubborn old mule is at.

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