Gait Retraining To Address Posterior Compartment Syndrome In A Runner

HISTORY: 23 yr old F presented w/ burning sensation localized to BIL central calf w/ running. Symptoms began at age 17 during cross country, where she experienced “burning” at 1 mile of running which resolved w/ rest. She managed symptoms w/ mileage & speed reduction along w/ PT. Symptoms returned Jan 2023 w/ an increase in her running. Faster walking or climbing hills also provoked symptoms. Compartment testing performed demonstrated increased pressures in the post. compartment BIL. PHYSICAL EXAMINATION: Pt presented w/ pes cavus, femoral IR & recurvatum in standing. Mild calf tightness w/ decr. talus mobility on R was noted. Strength test revealed decr. foot intrinsic & extrinsic strength w/ symptoms developing after 10 SL heel raises & weakness in gluts R > L. DIFFERENTIAL DIAGNOSIS: Chronic exertional compartment syndrome of BIL post. legCalf StrainPopliteal Artery Entrapment Syndrome Lumbosacral Radiculopathy TEST AND RESULTS: Running Gait Analysis Mid foot strike w/ R toe out, incr. pronationIncr. hip ADD, IR, CPD Decr. knee flex at foot strike Upright posture & ant. pelvic tiltCadence 160 spm High vertical load rates FINAL WORKING DIAGNOSIS: Clinical dx of chronic exertional compartment syndrome of post. legs w/ symptoms provoked while running w/ a midfoot pattern & high load rates. Poor prox. control during stance phase of gait may incr. calf demand. Gait retrain goal is to reduce load rates & modify footstrike pattern to alter demands to post. leg. TREATMENT AND OUTCOMES:Pre-Gait Retraining 1 Improve foot intrinsic/extrinsic strength & calf tolerance to load 2 Incr. lumbopelvic strength to improve dynamic alignment Gait retraining 1 Wearable sensor feedback: Use of tibial accelerometer fastened to distal leg w/ auditory feedback when exceeding threshold of 5.5Gs2 Mirror feedback: Instructed to reduce hip ADD & incr. trunk lean to improve gluteal activation 3 Auditory: Metronome set at 170 Feedback gradually faded Pt reduced vertical load rates by 42% by transitioning from a midfoot to a rearfoot strike pattern. She exhibited reduced hip ADD, CPD & improved trunk lean w/ cadence at 173 spm. She is able to run pain-free up to 50 min, 4 x/ wk. While rearfoot strike pattern is often associated with higher load rates, this case illustrates how multiple aspects of running gait can be modified to achieve desired goals of pain free running.