Footwear Modification And Gait Retraining For The Treatment Of Distal Leg Pain - Running

HISTORY: 36yo F runner presented w/ bilateral anterior leg pain L > R. Symptoms began Fall 2019 during half marathon training. She was seen by physician in Spring 2020 who recommended gait modifications. She continued to run and stopped due to pain in December 2021. She started PT in January 2022 w/ no change in symptoms over 8 weeks of treatment. June 2022, both XR and MRI were obtained of BIL LE, no evidence of soft tissue or bone stress injury. Anterior and lateral compartment testing in July 2022 demonstrated elevated anterior compartment pressures and high baseline pressures of lateral compartments. Advised to stop running and consider compartment release surgery. Evaluated at a running specialty physical therapy clinic in November 2022. PHYSICAL EXAM: -Strength limitations: lower abdominals, R hip ER, and BIL knee flexors -ROM deficits: hip ext, ankle DF and eversion-Hallux valgus L > R-Leg length discrepancy L LE 4 mm > R LE-Decreased muscle length: TFL BIL, quadriceps BIL and, L gastrocnemius-No TTP or pain w/ hop testing DIFFERENTIAL DX: -Chronic exertional compartment syndrome-Popliteal artery entrapment syndrome-Anterior tibialis stress syndrome -Lumbar radiculopathy TEST AND RESULTS: Running Gait Analysis-Cadence: 167 steps/min-inversion L > R-Mid to forefoot strike L, forefoot strike R-Mild over-pronation L, toe out L > R-Overstride on L-Hip adduction L > R, contralateral pelvic drop L WORKING DX: Symptoms from anterior and lateral chronic exertional compartment syndrome during running may be addressed through reducing heel to toe drop of footwear and modifying foot strike pattern through gait retraining TREATMENT: Pre-Gait Retraining-Foot/ankle strength and proprioception exercises: heel raises, foot core and balance, progressing to plyometrics-Lumbopelvic motor control exercises. Gait retraining-Transition from a cushion neutral shoe w/ 10 mm heel to toe drop to partial minimal footwear w/ 0 mm heel to toe drop-Cadence feedback >/=172 steps/min-Instructed to use lower abdominals and gluteal muscles while running. Provided visual feedback to reinforce alignment and maintain neutral pelvis.-Faded feedback design to achieve 30 min of running OUTCOME: -Increased run cadence by 5%. Transitioned to a partial minimal running shoe-Returned to running 60 min w/ use a gait retraining program w/o pain