Chi running is one of the many different running forms that are being promoted as a means to run better, feel better about running and get fewer injuries. Chi running as a concept was first promoted by Danny Dreyer who developed it as part of his ultramarathon training program. As a technique it advocates a more forward lean of the torso and more of a heel strike as opposed to a heal strike. Most of the support for Chi running is based on testimonials and there is no research that supports it as being any better than any other running technique.

I have been seeing more posterior tibial tendonitis lately. If I did not know any better, I would say it was getting more common. This would be consistent with the increased interest in barefoot or minimalist running. This running technique which is a forefoot strike compared to a rearfoot strike makes the posterior tibial muscle work harder, so no wonder that posterior tibial tendonitis is becoming more common with the trend to these types of running techniques (which also include the Chi ad Pose forms). The symptoms of posterior tibial tendonitis are generally felt just above and/or just below the medial malleolus and sometimes down into the arch of the foot. The treatment or posterior tibial tendonitis is to reduce the workload of the posterior tibial muscle. This usually means foot orthotics and reverting to heel or rearfoot striking. The rearfoot striking may only need to be temporary and a transition can be made back to the forefoot after the problem as resolved.

The plantar plate is an important structure of the first metatarsophalangeal joints in the foot. The plantar plate is part of the plantar fascia and is a thickening of the plantar aspect of the joint capsule. Plantar plate dysfunction is a common cause of pain under the first metatarsophalangeal joint. Ultrasound often demonstrates a plantar plate tear that may need surgical repair. The treatment of a plantar plate dysfunction is initially to use something like a metatarsal pad or strapping to plantarflex the toe to allow it to heal. Often a metatarsal pad may need to be used long term.

Sesamoiditis is a common problem in athlete with high loads under the first metatarsophalangeal joint. It is not really a sesamoiditis, as it is an inflammation of the soft tissues around the sesamoid bones at this joint. The pain of sesamoiditis is usually on direct palpation of the area. Imaging is sometimes useful to rule out a fracture of the sesamoid bone. The reason for the higher loads is due to the structure of the foot, most common a higher arched foot with a plantarflexed first ray which when combined with higher levels of activity can create this problem. Sesamoiditis can also be more common in sports that involve pivoting on the first metatarsophalangeal joint such as tennis. The initial treatment if sesamoidtis is the use to offloading techniques in foot orthoses to reduce the load on this structure. Sometimes adding an anti-shear cover to the foot orthoses will help with the pivoting motions. If conservative measures are not successful, then surgical management such as elevating the first metatarsal or the more drastic measure of removing the sesamoid have been tried for sesamoiditis.

This is a common problem in athletes. Sinus tarsi syndrome generally occurs in two situations that are almost opposite to each other. One is that the structures in the sinus tarsi can be damaged during an inversion ankle sprain. Often this problem goes undetected until some of the original ankle sprain settles. The other condition is an excessively flat or pronated foot that pushes the subtalar joint to its end range of motion and compresses the tissues in the sinus tarsi. In both cases there can be a feeling of instability and pain is generally palpated over the sinus tarsi on the lateral side of the ankle joint.

Treatment is mostly done with physical therapy in both situations. Foot orthotics are generally needed if the causes is a flat pronated foot. Occasionally a series of steroid injections into the sinus tarsi will be helpful.

For the latest on sinus tarsi syndrome, see Podiatry Arena:
What actually hurts in sinus tarsi syndrome
Foot orthotics for sinus tarsi syndrome

Exercise for those with diabetes is extremely important. It is important for general health and fitness as well as weight control. There are also some diabetes specific benefits of exercise for those with diabetes such as assisting in glucose controls and also in type two diabetes its also has the affect of increasing insulin sensitivity. Those with diabetes who exercise need to take precautions such as the timing and amounts of insulin injections relative to the timing of exercise. There is one other problem that those exercising need to be conscious of and that is the ‘diabetic foot’. The foot is at increased risk for damage because of the diabetes and that damage may not be detected. Stress fractures are more common in those with diabetes and in the worse case; a Charcot foot problem may develop. Those with diabetes and sign of peripheral neuropathy are at greater risk for diabetic foot problems and are probably better off avoiding weight bearing exercise and take part in activities like cycling and swimming.

The April 2010 edition of  Podiatry Today magazine has a good update of the latest concepts in Medial Tibial Stress Syndrome by Kevin Kirby. Two interesting key concepts that came through in the review is that there is no agreement on exactly what is the pathological process in the condition – is it a soft tissue traction issue or a bone stress reaction due to tibial bending actions?  The tibial bending moments are a recent consideration in the risk factors for this condition. If medial tibial stress syndrome is due to tibial bending moments, then this has implications for the use and prescription of foot orthotics and running shoes to alter these bending moments. There has been some discussion on this concept for medial tibial stress syndrome.

In a recent edition of Radiological Medicine there is a new study that investigated the use of a weightbearing MRI to assess those with plantar fasciitis. They were able to report that the changes in the MRI signal that was associated with plantar fasciitis when compared by blinded examiners in those without plantar fasciitis. Unlike the usual ultrasound finding, the thickness of the plantar fascia was reduced due to stretching in the weightbearing position compared to the supine position. This is an importantt observation given the emphasis  that gets put on the thickness of the plantar fascia with ultrasound measurement which is done non-weightbearing. The important finding in this study was of 15 cases that they looked at, 4 had partial tears of the plantar fascia visible on the weightbearing MRI. This has implications for sports medicine as a number of the cases of plantar fasciitis that are seen, may infact be partial tears.

There has been a lot of recent attention given by the media to barefoot running. Recent publications by Kerrigan et al and Liebermann et al have been widely promoted in the news media and on running barefoot websites. Both studies have been badly interpreted and misrepresented by the media and barefoot running websites as showing something that they did not show. Liebermann even went to the extraordinary step of posting a disclaimer on his website about how his research was being used! See these two analyses on Podiatry Arena: Barefoot Running Debate and The Effect of Running Shoes on Lower Extremity Joint Torques and these two from an anti-barefoot running website: Hook, Line and Sinker and Yet another study they fell for!

Despite claims made by the barefoot running community, there is no evidence that running shoes do any harm. There is also not any evidence yet that running shoes do any good either. There is also no evidence that barefoot running is any better than shod running. Barefoot runners also appear to be somewhat irrational in the way they involve themselves in discussions of barefoot running, having been compared to zealots! For more, see these videos on barefoot running.