This individual came to us with complaints of being limited to running 1 mile secondary to pain. He described the pain located along the medial tibia as developing after about half a mile in and progressively worsening. Upon cessation of activity, the pain would gradually lessen. Take a look at his running form below:
One of the components that really stood out to us was the significant vertical displacement between each stride. That combined with an excessively prominent heel-strike led to our thoughts of poor foot intrinsic control. Check out the images below to see what we found upon visual inspection:
As you can see, he has some significant pes planus bilaterally. While we did not do a formal evaluation, we did find that he has limited dorsiflexion and strong tibialis posterior bilaterally. The individual was able to point to a specific spot of pain that was increased upon palpation after running. This led us to believe the possibility of stress fracture might be present. Testing with a tuning fork was negative. We believe this individual could be suffering from Medial Tibial Stress Syndrome.
We have long been interested in how shoe-type affects running mechanics. Below are videos of running in 4 different types of footwear: Asics, Nike Frees, New Balance Minimus, and Barefoot. There is a progression from restrictive footwear to barefoot. Asics are your traditional running shoe in that they provide extensive heel cushioning. Nike Free represent a movement towards the minimalist side. While Nike proclaims the shoes are a minimalist shoe, it still has significant heel cushioning. However, the flexibility of the forefoot allows for greater intrinsic foot muscle control. The New Balance Minimus is one of the shoes on the market that is closest to simulating barefoot running, while still providing protection to the tissue of the foot. Barefoot is pretty self-explanatory. Additionally, the runner was recorded at 2 speeds, jogging pace and a faster paced run, for each shoe type.
-Increased smoothness as footwear advanced towards barefoot
-Heel-strike most prominent in Asics. While heel-strike was notable with Nike Frees, it was not as exagerated.
-Interestingly, decreased based of support with the New Balance Minimus. The stance leg crosses into midline, while in the other shoe-types the stance leg stays ipsilaterally.
-At the time of this recording, Chris primarily ran in the Nike Frees, but running in the New Balance Minimus felt like it had the lowest energy expenditure.
-The Asics fatigued Chris the most, likely due to the increased plantarflexion torque. Chris' dorsiflexors weren't used to having to compensate for plantarflexion torque caused by the increased heel cushion during heel strike.
-While barefoot running felt comfortable on Chris' calves, the stressed placed on his MTP joints prohibited him from running barefoot for prolonged periods.