Tendonitis and Calf Problems!!! (Full Version)

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mgiard3 -> Tendonitis and Calf Problems!!! (March 23, 2008 6:23:35 AM)

I am having problems solving a case with post-tibial tendonitis and pes-planus (flat feet).  The shin pain has subsided gradually, but the main problems is the calf and achilles tendon tightness.  After 2 months of substantial therapy with therabands, stretching, and calf strengthing exercises, running lightly was still a problem.  Achilles became tight and so did the calf muscles from not being used for so long.  Is there any suggestions that you could have to this problem?  Any suggestions on rehab that has worked and how the progression back to running can be made?  Should I cut out bikig\ng and swimming all together before the muscles are fully healed?  I am lost with this case.  Thanks to all.




TexasOrtho -> RE: Tendonitis and Calf Problems!!! (March 23, 2008 1:10:49 PM)

Hey there M.  Would you mind giving a history of the patient and the problem?  Sounds like there might be some "between the lines" issues at play with this patient.




mgiard3 -> RE: Tendonitis and Calf Problems!!! (March 23, 2008 2:29:17 PM)

He is 23 years old and weighs 190 pounds.  He was a powerlifter for 3 years and gained a good amount of weight over time which caused his flat feet.  When he picked up running to shed some weight a couple years ago, he got shin splints severely.  After taking it easy to avoid pain, he picked up running again for fun and the pain came back.  The doctor diagnosed him with Bilateral Post-Tibial Tendonitis.  After 2 months of rehab, his shins do not hurt to jog on the treadmill, but one day went outside to run for 10 minutes and his calf was severely tight and his achilles tendon hurt.  After taking off a week when the pain subsided, he thought running on the treadmill was not the same workout as running outside (which is what he eventually wants to do). So he ran for 3 days on the treadmill at 4 degrees incline (to try to simulate the push off effect running outside has) for 6 minutes and had the same pain and tightness as when he did ran outside 2 weeks ago.  When he was was running flat on the treadmill before that initial run outside, he was up to 14 minutes with no pain or strains and slowing increasing a minute every other day.  Thats the case right there.  He thought if he kept increasing 1 minute every other day on the flat treadmill that he will never fully simulate running outside and he wanted a faster transition to outside running.  Meanwhile, the biking and swimming he does seems like no hinderance on his performance, but maybe they should be stopped until he is fully healed?  Need HELP!  Thanks yall! 




jma -> RE: Tendonitis and Calf Problems!!! (March 23, 2008 3:21:32 PM)

How does his feet feel with prolonged walking or standing?




mgiard3 -> RE: Tendonitis and Calf Problems!!! (March 23, 2008 3:49:38 PM)

He has special orthotics made for his feet and they really help.  He stands all day at work and he has noticed a great difference.  Really has no experience with prolonged walking, but the pain he used to have in his feet have gone down due to the orthotics.




jma -> RE: Tendonitis and Calf Problems!!! (March 23, 2008 4:31:47 PM)

It sounds like he has a biomechanical problem that seems to be relieved with orthotics. Does he use the orthotics when he is running? I would think that there would be different ones that could be made for just that purpose.




mgiard3 -> RE: Tendonitis and Calf Problems!!! (March 23, 2008 5:40:55 PM)

Yes he does wear them when he runs.  They help a lot with his shin pain, but it seems like his calf is not strong enough to support his weight.  He is also trying to lose weight to help lessen the pounding.  What treatment route would yall go? Thanks!




mgiard3 -> RE: Tendonitis and Calf Problems!!! (March 25, 2008 5:27:20 AM)

Need some treatment advice, if possbile?




Sebastian Asselbergs -> RE: Tendonitis and Calf Problems!!! (March 25, 2008 10:45:50 AM)

First off, what is there to heal?  Why do you think that there is some kind of damage?
Just because there is pain, does not mean there is any damage....  There are many neural entrapments that are very painful - simply due to mechanical stresses.  Butler  has written extensively on the sensitivity of the nervous system, and you can find quite a few interesting entrapment ideas in his writings. Check this one out too:
http://books.google.ca/books?hl=en&id=le_R1Llja94C&dq=tunnel+syndromes&printsec=frontcover&source=web&ots=lQz78DRz0U&sig=W16cYPRabyW8i_GnT197zYxnxgM#PPP15,M1

But gently testing for nerve sensitisation is best checked from Butler's view for those first venturing out into this area.

That is my first suggestion. My second one is - do not strengthen any further. Your case report does not indicate anywhere that there is a weakness in any of the muscles, and with this guy's history, I doubt that strength is an issue anyway - he strengthen for 2 months!
The fact that he apparently "feels" the calf does not support him - even after all of that strengthening, is a potential sign that nerve entrapment is involved. The body will do quite a bit of adapting - including inhibiting muscle activity or limiting ROM - to protect nerves.




daveclan08 -> RE: Tendonitis and Calf Problems!!! (March 31, 2008 3:24:01 PM)

I agree with Sebastian, also check for Trigger Points which might respond to digital pressure or even Dry Needling.
  1. Neural Component?
  2. Myofacial Pain?
  3. Walking for 20-30min instead of running?




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