Do you think our early ancestors wore half-length or full-length orthotic shoe inserts? Would their video-recorded gait assessments have revealed more under or over-pronators in the general population?

If we try to imagine how life was back in the day of the caveman we could safely assume that his ability to run both short sprints and long distances was necessary for surviving in a wild environment. Without the ability to track food or flee from dangerous predators the human evolution may not have been possible. What we can also be sure of is the caveman did not run in a pair of Asics trainers with rear-foot gel-cushioning outer soles structured for either a neutral or over-pronating gait . Nope, our early ancestors would have been running barefoot.

Many thousands of years later and despite our advances in footwear design and technology there is a ‘barefoot running’ revolution gaining traction in some circles. The idea is that we as a species have spent more time running barefoot than we have in our fancy high-tech shoes and therefore we are more physiologically suited to running barefoot.

Calf pain is more often a muscular complaint and we regularly treat such conditions here in our Physiotherapy clinic. However, calf pain can indicate a far more serious and dangerous health concern as I have been cautiously reminded of by a recent experience.

As Chartered Physiotherapists we are first-contact practitioners where patients can schedule consultations directly with us without having to go through their GP first. We therefore see many patients presenting with what they believe is muscular pain and dysfunction. In a recent case where calf pain was the complaint the more serious symptoms of Deep Venous Thrombosis (DVT) were presenting.

The medical training of Chartered Physiotherapists equips us with the knowledge and ability to identify these "red flag" symptoms and immediately refer for further medical review and investigation. As medical practitioners it is important we keep the differential diagnosis in mind and refer on if necessary.

Chartered Physiotherapists are trained to assess an acute (recent) ankle sprain and using a specific set of assessment criteria known as the Ottawa Ankle Rules we can determine if a fracture is likely to have occurred. If we suspect a fracture we can refer you for an X Ray or MRI scan (In Ireland, depending on your health insurance policy, you may need your doctor to sign off on the request). The results of the scan will help us decide how best the ankle should be managed and depending on the extent of the damage, an orthopaedic specialist may need to be consulted in addition to receiving physiotherapy.

Most ankle sprains result in soft tissue injury, usually to the ligament structures which support the ankle joint. The lateral (outer) ligaments are more commonly injured which may result in pain, swelling, restriction of movement and a loss of function e.g. walking properly, or ability to run and take part in sports. If this type of injury is not treated correctly, on-going weakness and instability may result, making further injury much more likely down the road. Simply taking anti-inflammatories is not sufficient.

In many cases, long term muscle imbalance exists already, an injury then occurs and an orthotic is prescribed to temporarily offload the injured structures to promote healing and recovery. 

In this situation, some biomechanics experts would argue that the orthotics, by placing the foot and ankle in a more ‘aligned' position, can actually help overcome and correct long term muscle imbalance, often with the help of corrective exercises and manual joint and soft tissue mobilisation techniques. This situation often occurs from the late teens onwards.

With Wimbledon fever well under way and a particularly injury prone year among the top seeded players I thought it might be interesting to have a look at the most common tennis relates sports injuries. Research has shown that there are 54 injuries per 1000 games played (Pluim et al 2006). Among the most common injuries are a sprained ankle, shoulder strain, calf strain, tennis elbow and back injuries. 

Let’s take a closer look at the sprained ankle.

The sprained ankle is highly common in both the elite and the recreational sportsperson. The sudden sprinting, side movements and change of direction as required in tennis can cause the ankle to twist, particularly if the player is becoming fatigued or are playing on a slippery surface. The likes of Andy Murray and Roger Federer will wear ankle braces during matches in order to reduce the risk of such injuries.

I recently received my first pair of custom made orthotics. I have to admit I felt as though this purchase decision was a bit of a leap of faith on my part. Other than my structured-cushioning running shoes designed for over-pronators I have previously taken no further consideration for my tendency to walk and run with flat feet which liked to roll inwards.

I share a few photo's of my new orthotics below as well as a comparison photo of my inward ankle roll with and without the orthotic in place. 

Why I opted for a pair of custom orthotics

There were a few reasons - the first; an ache and frequent twinge in both of my knees that was hanging around long enough to cause some concern. In the absence of any recent trauma I considered what might be causing the discomfort. I had recently switched to a new brand of trail running shoe which could have been a contributing factor.

I also have never forgotten the video-recorded running gait assessment I completed at the Asics store in London last year which revealed my relatively severe ankle misalignment on foot strike. Hence my choice to wear structured-cushion running shoes.

A client of mine has adult-acquired flat foot and presented with significant pain along the outside of the ankle and foot region when walking. She had been to see a surgeon who had suggested surgery but she was keen to see if there was anything Physiotherapy could do to assist with the view to possibly avoiding having to go down the surgical route.

What's the best technique to help with speed, efficiency and a reduced risk of running injuries? This has become a hot topic of debate with no firm conclusions. Its important to consider each runner as an individual and what works for one person may not work for another. I've been experimenting recently...