Lateral calf pain

Hi

I have been treating this lady with pain along the fibular mainly around the distal and proximal ends vary rarely int eh middle. She is a keen runner and used to run for about an hour 3 times a week with gym visits on top of that including a big weights program and low impact cardio.

The pain started as ITB friction syndrome and as she had extremly pronated feet i refered her to a podiatrist who gave her some insoles (this lateral knee pain went after some stretching etc(. She did her first run with the insoles with no pain when running but that night had really bad pain around the head of her fibular. she's kept resting and running (the pain is now when she runs) and for days after along the line fo the fibular, there doesn't seem to be anything thats working what could it be???

Can anyone help?

check whether the insole u provided fits properly also check whether there is any alteration of normal biomechanics due to that insole,ask her about effeciency of running after wearing that in sole

She says she feels much more 'springy' when shes running now with them in. I didn't fit the insoles they were made by a podiatrist who firstly suggested to keep running once a week to get use to them and now says she could try just taking them out?? i really didn't understand why, if he felt they were needed in the first place she should take them out?

Her foot position now looks much better though her knee position seems to be medially rotated if that makes any sence (this has improve since the insoles) but i can't imagine that it would have a huge impact of the area in question.

See below -edited post

Has she got any positive neurodynamic signs upon testing? (Slump, Passive SLR - ??possible Sural nerve bias) Symptoms sound a bit peripheral neurogenic in nature, especially the latent and prolonged onset of symptoms after activity. Her nerves may be a bit more sensitive with the correction of her longstanding faulty lower limb biomechanics by the way of her orthotics, which may also have an affect on the mechanics of her lower limb nerves, triggering some neural signs and symptoms upon higher impact activity like running?

She may need to gradually increase the time spent wearing her orthotics before attempting higher impact activities like running. Lower limb neurodynamic assessment and treatment may be a consideration?

She may also need to address other factors including training intensity, running technique, reinforcement of correct warm up / stretches / cool down after running etc.

Jeni B,

With the orthotic prescibed by the pod is the rearfoot inverted to 2-4 degrees, if so this is your problem.
ITB syndrome is usually a good indicator that the hip is not externally rotating probably, therfore placing the pt is a hard inverted rearfoot device will send the glut med/ min into over -activation, thus the referred pain in the insertion of the peroneal muscle.
Chris

Hi
i agree with u guys, reassess pelvic balance, try change jogging pattern, strenthen foot supinators, all the best
Yaro