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Over supinating running gait

Question: Over supinating running gait

I have been suffering from recurring achilles tendinopathies for the last 2 or 3 years, which I believe began when I incorrectly got myself a pair of arch supporting trainers.

When I run now, I have noticed that I seem to land on the outside of my forefoot, which I think must be keeping me in this loop of achilles pain that won't seem to shift.

I am working on improving dorsiflexion, as well as finally committing to the eccentric heel-drop training, but am concerned about re-educating my gait properly in case this is a crucial factor. Could weakness of my lateral hip musculature be a factor here as well?

Does anybody have any ideas? Thanks!!

Answer:

Hi,

In my experience as a physio and gait analysis technician there may be several factors causing the achilles tendonopathies which you could use as a series of elimination.

Firstly, landing on the outside of the forefoot does not mean you are a suprinator, generally if you watch anyone running from behind you will see varying degrees of ankle inversion prior to landing, some will land on the heel, some mid foot and some forefoot; if you definately strike on the forefoot you may be over stressing the achilles/soleus/gastrocnemius as the more you land towards the ball of the foot and toes, similar to that of sprinters the harder those muscles are having to work(in simple terms).

Secondly, lets discuss shock absorbency; as we strike the foot pronates, which is a normal part of the process of absorbing ground forces, if however the foot continues to pronate and does not recover, commonly termed the over-pronator it could potentially lead to injuries of the achilles, calf, knee, hip and back (not exhaustive). If you are landing with your foot extremely inverted(on the edge of the foot), it is very important to check what happens to the foot thereafter; does the foot move through the pronation phase too quickly, in layman's terms, does the foot fall towards the floor very quickly and even a small degree of excess pronation will heavily over stress the achilles. If you have been wearing shoes that have been too supportive, effectively not allowing you too move through the initial shock absorbency phase of pronation it is well worth having your feet looked at by an osteopath to ensure your foot is functioning properly and all the joints of the foot and ankle are moving, as stiff joints leads to poor shock absorbency.

Your running technique is also worth looking at; are you a long strider?, are you very upright in posture?....if so decreasing stride length and increasing cadence can prove more effective. Posture in efficient running is key, so allowing a small forwards lean of the whole body encourages gravity to move you forwards with less effort and helps foot striking under the hips. The points on technique are less likely to be the main reasons you are suffering from an ongoing achilles injury, however there is usually a link to one of the early points.

You rightly mention the potential involvement of the lateral hip musculature, if you have poor pelvic stabilisation, again it could be playing a part. There are two ways to rule this out, allow someone trained in biomechanics and true gait analysis (that looks at more than just the foot) to check your pelvis whilst running and/or a standing Trendelenburg test and gluteus medius function and strength test. If you are seeing a physio or osteopath, get them to check for SIJ disfunction and this also effects shock attenuation negatively which can also contribute to achilles injuries.

My advice would be to get someone well training in gait analysis to have a look at you and also a sports physio if there is nothing obvious from that.

If you have any more questions, I will be more than happy to help

Nicky

Answer:

Thanks for the detailed response!

I was a sprinter when I was younger, and have therefore always had more of a forefoot strike. I never had any problems before, although being less active and a bit older could be a factor. I do however feel that the start of the problems was around the same time I changed trainers.

I'm not sure that there is much pronation or dorsiflexion going on at all anymore. I have felt that when I stretch there is more of a physical boney block, rather than muscular restriction. So, yes, I do think some mobilisation might be needed.

I've always ran with a forward lean and short stride length. I guess if I'm honest, I probably have a lot of flexibility issues, and every possible active trigger point in the calf and glutes. Obviously I need to go and get checked out, but cannot really afford multiple sessions...such is life!

Could the lack of dorsiflexion be partially to blame for my inverted foot strike? I want to run on the ball of the foot, like I used to, but my foot just wants to impact on the lateral meta-tarsal regions regardless! There may also be some medial swing before foot-strike which is perhaps not helping? Maybe again due to a Trendelenburg dysfunction?