Medial Tibial Stress Syndrome in Runners

That aches-a-lot feeling runners will recognize – a dull ache along the inside of the lower leg that begins soft but eventually becomes a pain that cannot be ignored. Medial tibial stress syndrome (or medial tibial stress reaction) is one of the most common overuse injuries in runners, representing about 10-15% of all running injuries. It affects the beginner racer logging their first few miles, marathon athlete hitting her high-volume training block, and everyone in between.

Here’s what is really going on in that tissue, and how that knowledge can help you make smarter decisions before you get hurt.

What Is Medial Tibial Stress Syndrome?

MTSS is pain running along the posteromedial edge of the tibia – or the inner lower part of the shin – due to excessive pain generating forces. The sensation is generally described as dull and achey and may be felt over a fairly large area (greater than five centimeters). This is in contrast to a tibial stress fracture, which is frequently very precisely localized to one specific point.

It occurs in response to repetitive mechanical loading that exceeds the bone’s ability to adapt, rather than through any acute traumatic event. It’s exactly that incremental progression which causes runners to ignore early signs of trouble.

Causes, Risk Factors, and Warning Signs

The top three causes of MTSS are: the volume increase is too rapid, hill work is added prematurely before you’re ready and running surfaces are too hard too soon. These are the three leading reasons why the tibia is overwhelmed for a period of time that it just can’t handle it. Those three conditions place stress on the tibia before it’s ready to accept the load.

Common biomechanical factors include overpronation, low arch structure and weakness around the hips. If shoe wear is old or doesn’t match your gait pattern, this can compound the effects. A previous history of a lower limb injury and sex have also been identified as risk factors in the clinical literature.

If the pain feels worse as a run progresses, it does not settle after your first mile and the pain lingers during the next day or two, it needs investigation. Sharp, localized pain, especially if it is associated with swelling, could be a stress fracture and that difference makes a critical difference.

Diagnosis and Evidence-Based Treatment

The clinician will evaluate the distribution and profile of symptoms and go over the history of training and examine gait mechanics. Although imaging may not always be indicated an MRI can help confirm the diagnosis of a MTSS case or exclude a stress fracture if the symptoms are unclear. Management of tibial stress syndrome focuses on relative rest (not pain-free rest, just lessen the intensity of the loading sufficiently to allow the tibia stress to diminish).

Avoid high-impact activities and focus on lower impact cross training modalities like aquatherapy or cycling, strengthening the calf complex, hip abductors and intrinsics of the foot. Increase running cadence very slightly as it will reduce tibial loads at runner.

Safe Return to Running and Prevention

A graded return is normally done pain-guided. If the pain is below three out of ten during running and recover within 24 hours of finishing, then it is usually considered safe to run again. Running mileage can be increased by no more than 10% per week; running on softer surfaces, getting adequate sleep and nutrition for bone, and replacing running shoes after every 400-500 miles all lower the risk of a repeat injury.

Doing strength training 2x/week (not just when injured) is probably the runners’ most under-utilized prevention tool.

MBT Footwear: Benefits, Fit, and Buying Guide

One shoe brand that sparks even more questions than the odd shape of their soles is MBT Footwear. Whether you’ve seen those funny looking shoes at the gym, or just heard from a colleague that they just survived the streets on their feet on a long day at work, MBT shoes really have taken a surprising and iconic place in the shoe industry. The company, which stands for Masai Barefoot Technology, was founded back in 1996 with the main idea that a special sole could transform the way the human body moves.

Here’s everything you need to know about MBT shoes, what they do, what they might do for your body, how to pick the right pair, and whether they’re really worth the investment.

What Is MBT Footwear Technology?

MBT Footwear comes from the observation of Swiss engineer Karl Müller that when you walk on uneven soft natural terrain (like soft soil, grass, or sand) it seems easier on the joints than walking on hard, flat man-made pavement. His solution was to construct this softness into the shoe. And that is what makes the MBT sole unique – its one of a kind curved, multi-layered sole that lifts the foot up off the ground on a rounded platform instead of a flat one.

How the Rocker-Bottom Sole Works

The unique rocker-bottom heel and sole ensures that every step produces a heel-to-toe rolling action instead of the strong jarring heel-to-toe strike common in flat shoes. What you will notice under the heel are sections of rounded “masai sensors” – soft pivot points that bring the foot rolling forward. We added a mid-foot stabilizer layer that acts as a natural side-to-side motion barrier and eliminates “wobbling” by some users when they first start using them.

The result is like walking on uneven ground that helps keep the flow of gait more natural and low impact on the joints.

MBT’s Main Product Categories

But the line up has something for everyone The line up breaks down as walking-specific styles, lightweight performance trainers, casual sneakers, professional work shoes for long shifts, outdoor and trail styles, formal shoes, boots, sandals and recovery shoes. The simply means there’s probably an MBT style for just about any daily activity, whether that be hospital hallways, wilderness weekends or city streets.

Potential Benefits of MBT Footwear

Much of the appeal of MBT Footwear lies in what that curved sole could do for the body during our normal walking or standing. Wearers have spoken about how comfortable the shoes are, especially after several hours on their feet. Because the pressure is spread over a larger surface area of the foot, hotspots in the heel or ball of the foot may be lessened.

That may be the most consistently experienced benefit.

Comfort for Walking and Standing

People on their feet for long periods of time — nurses, retail workers, teachers, warehouse personnel — quickly discover that flat shoes push the same pressure points day after day. MBT’s rolling sole can change that load distribution around, an experience a number of wearers report is significantly less tiresome after a full day. Additionally, MBT models tend to have particularly padded soles, while the midfoot stabilizer imparts a slight sense of support and stability missing from flat shoes.

Longer-distance walkers even notice a smoother transition from heel to toe on hard pavement.

What the Evidence Does—and Does Not—Show

Here’s the thing: MBT hasn’t been shy about claiming to us how they can toning muscles, address good posture and reduce back pain. But the evidence from researchers paints a more complicated image. There are some studies that show that shoes like MBT can improve load bearing and change the way your muscles activate while walking – which is kind of cool.

But there isn’t enough good evidence that MBT shoes work as a treatment for specific medical problems like osteoarthritis, chronic back pain, or even plantar fasciitis. They’re shoes, not therapy. If you have an existing health problem, consulting your physiotherapist or podiatrist before wearing rocker-bottom shoes is also a good idea.

Choosing the Right MBT Footwear

Finding the proper MBT model is less about choosing something you like the aesthetic of, and more about taking a trip with regards to activity type. MBT walking shoes you wear on a limited access road for paving will not end up being the same shoes you wear for treacherous mountain trails; an offhand sneaker will not be able to keep up with a long, hard nurse’s shift. Decide exactly where and how you’re going to wear the shoes before going shopping, because MBT styles are as varied as you are, and the wrong choice can be most painful.

Finding the Correct Fit and Size

The obvious starting point – but always measure both feet and size to the bigger foot. MBT suggests about a thumb width’s space between your longest toe and the end of the shoe and recommends this is more important with rocker-bottoms as the foot moves when the shoe is rolling; for the same reason it is not advisable to wear a shoe that is too tight in the toe box. If buying online, always compare your foot size to the brand’s conversion chart as sizing is different with each MBT range; try shoes on if you can.

Selecting the Right Sole and Upper

Varies between MBT styles – some sport deeper profiles, resulting in a more intense rolling feeling, while others are shallower and more subtle. Is the shoe more conducive for wet or mixed terrain?

Some MBT shoes will have deeper tread lugs and will feature waterproof uppers, while others will incorporate treated leather uppers. Breathability should be a consideration if you’re taking the shoes out for a walk in warm weather or engaging in physically active pursuits, meaning mesh panels are a consideration.

Adapting to MBT Shoes Safely

Rocker-bottom shoes really do feel different than regular shoes, at least for the first week. With its curved sole, your stabilizing muscles have to adapt to a slight state of imbalance. It’s the adjustment period that’s normal; neglect to give your body time to adapt and you risk soreness and even injury.

Breaking In Your First Pair

Begin with brief walks – 20 to 30 minutes – and monitor how your feet, ankles and calves feel. Most first-time wearers experience slight muscle fatigue in the calf region, that’s because those muscles are working harder than they’re used to. Build up your wearing time gradually, taking 2 to 3 weeks to work up to a full day, and only do so when the shoes are stable and comfortable.

When to Stop Wearing Them

Any ongoing pain, numbness, rubbing, or sensation of instability that feels progressively worse should be a cue to cease use and see a healthcare professional. MBT shoes are not intended for all foot types or mechanics, and pain is not normal or helpful.

MBT Footwear: Who Should Consider It?

A person who values walking comfort, is on their feet all day at work, or is seeking a softer, everyday alternative to a traditional walking shoe would all find MBT Footwear suitable.

Best Uses and Wearers

They are suitable for city walking, long travese days and commutes, for work environments that require standing for long hours. Those who seek for recovery movement, do not want to impact their joints and must stand long hours love them.

Important Considerations Before Buying

MBT shoes tend to be more expensive than most in the mainstream footwear market – in the range of about $100 to $200 plus, depending on the model. The style may not appeal to everyone. Also, they’re not the best choice for the technical or uneven terrain, unless you buy a style designed for outdoor wear.

Find out the retailer’s return policy, and if you have any issues with your joints or feet, getting fitted by an expert or seeing a podiatrist is time well spent.

Maximalist Running Shoes

Modern running shoes have evolved significantly over the past 20 years, but there’s perhaps no footwear trend as out-there as maximalist running shoes. These thick-soled, high-cushion trainers have now gone from ultramarathon finish lines and aid stations to more common sites like city streets. They’re beloved by both new runners and hardened road warriors – but the waters are muddied by a range of options from a host of manufacturers and a handful of questions about the virtues and limitations of maximalist shoes.

What Are Maximalist Running Shoes?

Maximalist running shoes got their name from their high-stack concept. That stack height is the amount of material sitting between the bottom of your shoe and the ground and that has traditionally been between 20mm and 28mm for standard trainers, Standard shoes come in around that range of 20-28mm depending on the design and the model. Maximalist shoes are significantly higher, with some designers getting up to 35-40mm or more.

That added height is almost always made up of foam to protect your foot from the shock of the ground as you land.

Key Design Features

The most apparent sign is the exaggerated midsole, but there is a lot more happening underneath. Many maximalist shoes have rocker geometry – a curved profile on the bottom which helps the runner roll forward rather than having to flex the toes to spring off. This design feature takes the load off the Achilles and the front of the foot.

Heel to toe drop ranges – some are nearly nonexistent, others have the standard 8mm to 10mm drop, and then there are wide platforms and reinforced sidewalls for side-to-side stability that offset that tall ride height. Add it all up and you are practically rolling along on a big firm mattress.

How Maximalist Shoes Evolved

Hoka One (which is now just Hoka) pioneered the oversized midsole among the trail running set way back in 2010, initially designing it with ultramarathoners in mind, to absorb jarring wear and tear over tough ground and huge mileage. The idea migrated nearly immediately. Road runners found that the cush to help with their training hours and long runs, and by the mid-2010s, virtually every major brand (Brooks, New Balance, Saucony, et al.) had their own big-sole shoes.

Benefits and Limitations of Maximalist Running Shoes

High stack shoes provide real benefit but they are not a cure-all. When you know the pros and cons, you will be better equipped to make an intelligent decision rather than just going with the trend or hype.

Potential Benefits

Impact reduction is the biggest obvious benefit. The thick foam in a maximalist shoe cushions impact all the way up your legs – ankles, knees, and hips – with each step, and this is especially important on long pavement stretches. For people with sensitive joints or those who have experienced significant stress to the lower body, many runners find that ultra-high-thickness shoes make long efforts more comfortable.

Running in an ultra thick shoe truly does feel easier, and there’s also protection from the rocks and roots that would otherwise abrade your foot and turn a trail run into a bruise fest; for ultramarathoners, this level of protection over 50 or 100 miles can make or break a finish.

Possible Drawbacks

Here’s the thing — more cushioning is not a guarantee of fewer injuries. No studies have indicated that shoes with the high stacks are any better than moderate cushion shoes when it comes to injury prevention. The thick midsole dampens what’s called proprioception, your foot’s ability to detect the ground and make immediate changes in your gait.

That diminished input can change biomechanics in ways that produce new stress points instead of eliminating old ones. The extra foam also weighs down the shoe and some runners find the tall, plush platform gives them a bit of a sloshy ride at speed and around sharp corners.

Who Should Wear Maximalist Running Shoes?

Matching type of shoe to type of run is important more than people think. Maximalist running shoes design is very well for some aspects of running, it’s not as good for other situations.

Best Uses

Easy runs and long-distance training runs are the shoes’ forte. During slower, more comfortable runs that are meant to be time on your feet more than anything else, a lot of kilometers are achieved. Recovery runs – slow, short runs coming between more intense training runs – are much easier on the joints in a cushioned shoe.

Trail runners or trail runners running technical terrain get a little more support under the foot in a cushioned shoe on rocky singletrack. Ultramarathon runners tend to wear maximal shoes as their primary footwear because no other style comes close to a maximal shoe for distance. Older runners, or runners with plantar fasciitis or knee osteoarthritis, sometimes find a little more comfort in a shoe with more padding.

When to Choose Another Type

Speed work and speedier workouts like track sessions and races require something lighter and firmer. If your shoe’s soft midsole is soaking up every ounce of energy that should be pushing you along, it’s still good for recovery jogging – just not during a speed session or a 5K. Heavily overpronating runners often need a stability trainer with firmer medial support instead of a lush, neutral shoe.

And if you’re just learning to run, wearing a very cushioned shoe before the muscles of your foot and leg develop any strength will obscure crucial sensory input your body needs those first few weeks.

How to Choose the Right Maximalist Running Shoes

Purchasing a maximalist shoe that hasn’t been properly tried on is a bit of a shot in the dark. Well-fitting shoes are immediately comfortable, not “break in over 50 miles over and over again” comfortable.

Fit and Foot Shape

Toe-box room is everything. You need approximately a thumb’s width of room in the toe area, and your toes should splay comfortably without crunching against the sides of the shoe. Wide-footed runners need to find brands that carry wide width models if that’s necessary — many don’t.

Secure your heel; if it slips when you take the shoes for a quick jog up and down the aisle, then no amount of padding will save you in the long run. Always try your new shoes on with your runninng socks on, too — sock fit can surprise you.

Cushioning and Ride Characteristics

Foam Midsole foam quality can vary from shoe to shoe and throughout each brand’s range. Some maximalist shoes are quite soft and cushioned, others are surprisingly firmer and more responsive given their height. You can’t always gauge this simply by how high the shoe is off the ground – a thick, 38mm shoe can feel more stable and harder while a thinner, 33mm shoe can feel more soft and compliant.

Rocker geometry will influence how each shoe rolls through your stride – is the roll natural feeling for you?

Will heavier runners squish the foam faster?

Transitioning to Maximalist Running Shoes Safely

Transitioning from one trainer to a high-stack shoe immediately can be a costly mistake. Your muscles, tendons and overall movement patterns require some time to adapt to the change in ride qualities.

Building Running Time Gradually

Begin small – try 20-30 minute runs in your new shoes before taking it on longer runs. Mix up your new maximalist shoes with your old shoes for the first 2-4 weeks. This allows your body to adapt, without overwhelming tissues that haven’t yet been exposed to the new biomechanics.

Slowly build the miles you are doing in the new shoes each week instead of jumping straight in with a full switch.

Signs of a Good or Poor Match

Good signs include comfortable landings, seamless heel-toe shifts, and a lack of new fatigue post-run. Conversely, a new pain in the ankles, knees, or hips – if you didn’t already have it – indicates the shoe doesn’t fit your mechanics. Numbness, slipping heels, and a sense of “loosening” when turning corners should be taken just as seriously.

You shouldn’t feel like you’ve added a new problem to your life when you slip on a new shoe.

Pseudoscience of Magentic Insoles: Do They Work?

Magnetic insoles have been on the market at pharmacies, sports shops, and internet sites for many years now. The marketing seems to offer much – pain relief, improved blood flow, quicker recovery, renewed energy. If you suffer with chronic foot pain or fatigue, that promise is enticing. However, examining the pseudoscience of Magentic Insoles reveals significant gaps between marketing claims and scientific evidence.

But the pseudoscience of magnetic insoles needs to be examined, because the space between what is being claimed and what scientific research shows is surprising. This article unpacks the science and offers some helpful information about what you can do to make a smarter decision on your foot care.

What Are Magnetic Insoles?

Magnetic insoles are shoe inserts containing small static (not pulsed or switching) magnets, which are typically made of ferrite or neodymium. They are used as part of a treatment for various conditions or as a wellness supplement by being placed inside shoes and maintained in contact with the bottom of the foot. Unlike medically fitted orthotics, which are prescribed to correct structural problems such as overpronation, leg length difference or plantar fasciitis, magnetic insoles are sold as a generic wellness product and the magnetic field they produce is not pulsed or switched.

Claims Made by Magnetic-Insole Sellers

The marketing hype around these products is impressive. Most vendors say the magnetic insole reduces chronic pain, improves blood flow, alleviate inflammation, increase energy, enhance balance, and speed up athletes’ recovery. Several go as far as to say the magnets work with the iron in your blood cells to “recharge” your body, or something similar to that, basically claim it recharges you and helps return your body to some sort of neutral electromagnetic state.

Again, these are pretty bold physiological claims – and, for the most part, they’re simply not backed by good scientific clinical trials.

Why “Magentic” Is Often Misspelled

The fake medicine of magnetic insoles will often be searched with the misspelling “magentic” – an n and e reversed. It’s an innocent mistake and a worthwhile mention because this article gets read by a large number of skeptics and tentative believers searching by this spelling. It makes no difference to the nature of the topic as whether n or e is used.

The Pseudoscience of Magentic Insoles Evidence

A handful of trials have compared magnetic insoles with nonmagnetic, sham insoles. The bottom line, according to what those trials say: magnetic insoles work no better than identical-appearing insoles without magnets. The pattern is as we’d expect if the insole effect was placebo or mechanical: Both groups improved as compared to no treatment, but there was no discernible difference between the two groups.

Findings From Randomized Controlled Trials

One often quoted RCT in the Archives of Physical Medicine and Rehabilitation study evaluated magnetic vs. sham insoles for diabetic peripheral neuropathy and found decreased foot pain and improved sensation over time for both groups, with no significant difference between the magnets and sham devices. Other researchers have had similar results when testing for plantar heel pain and general musculoskeletal pain. A Cochrane-style systematic review of magnetic therapy for pain summarized: “There is not enough good-quality evidence to recommend static magnets for pain.”

What the Evidence Can and Cannot Prove

It’s reasonable to be cautious in jumping to any immediate, concrete, conclusions here. Many of the studies in this field involve relatively small sample sizes, short follow-up periods, and pain populations that vary in several different respects – all of which significantly constrain what can be responsibly said based on the evidence. And while lack of good evidence isn’t the same as evidence of a null effect in all cases, the fact remains that claims which run counter to scientific consensus require scientific evidence.

And 30+ years of testing has failed to turn up reliable, repeatable results to support the language with which these products have been sold.

Why Pseudoscience of Magentic Insoles Claims Persist

Pseudoscience is NOT “it hasn’t been proven”. It is a claim that refers to its use of scientific-sounding language and failure to account for the nature of scientific testing. Magnetic insole marketing often references “biomagnetic therapy,” “ionic energy,” or “quantum resonance” without including an explanation of the mechanism or a prediction to test against it.

The Circulation and “Energy” Claims

Magnets draw blood and “improve” the circulation: Incorrect – Magnets do not draw blood and they do not “improve” blood circulation. Yes, blood contains iron, but the rusting iron in hemoglobin is not attracted to a permanent (magnetic) magnet like the iron on your refrigerator is attracted to your refrigerator. The powerful magnetic fields used in clinical MRI machines are thousands of times stronger than any shoe insole magnet, and, for all their might, have zero effects on blood flow.

The same general idea applies to the “energy boost” assertion.

Placebo Effects and Ordinary Insole Benefits

It doesn’t mean wearers of magnetic insoles get no benefit. Some truly do feel less pain – and that counts. The problem is that the benefit can most plausibly be attributed to things like extra padding, better pressure distribution under the foot, a marginal alteration in gait dynamics, or the placebo effect of taking one positive step towards solving an aching feet problem.

A standard gel or foam sole can do this, too.

Risks, Regulation, and Consumer Red Flags

In most countries, magnetic insoles are treated as low-risk consumer products, not as medical devices, which means they undergo less regulation before hitting the shelves. This regulatory shortcut enables sellers to make broad wellness claims without clinical proof.

Who Should Exercise Caution?

People with any implanted medical device including pacemakers, implantable cardioverter-defibrillators, or insulin pumps, should not use magnetic insoles at all, because even weaker magnets can affect the device. People who have diabetes-related sensory nerve damage (peripheral neuropathy), poor sensation in their feet, or active foot wounds should seek medical advice rather than self-treat using unproven products, because delayed diagnosis can lead to catastrophic outcomes.

Warning Signs of Misleading Marketing

There are many red flags that indicate the marketing of a magnetic insole may not be valid. For instance, if a company claims that their product will “cure” your pain and uses “clinically proven” statements without referencing peer-reviewed research then be wary. Testimonials, “studies show”, lack of specificity and the statement that a product replaces medical care are other warning signs.

Evidence-Based Alternatives for Foot Pain

There is actual, treatable reason for foot pain – and there are a number of evidence-based solutions that do not involve magnetism.

Choosing Insoles for Comfort and Function

Medical-grade insoles that are built for even distribution of pressure and absorb shock in the heel, arch support, and metatarsal support or pressure relief zones have shown to provide help for plantar fasciitis and flat feet. Off-the-shelf orthotic insoles from a well-respected maker can provide benefit if purchased with the proper fit for activity and foot type. Custom orthotics from a podiatrist are best for your condition.

When to Seek Medical Advice

Foot pain that lingers or worsens, redness and swelling, numbness or tingling, skin discoloration, or any wound on the foot is something that needs to be checked out by a healthcare professional-not a walk down the isles of an insole retailer. These symptoms may indicate medical conditions such as circulatory problems, nerve injury, or stress fractures, all of which should be properly diagnosed and treated.

Lateral Shoe Wedging for Knee Osteoarthritis

More than 20 million people worldwide suffer from knee osteoarthritis and the prospect of non-surgical relief fuels significant interest in easy, inexpensive treatments. Lateral shoe wedging for knee osteoarthritis is one of these approaches – you place a small wedge under the sole of the foot that would tip the foot outward and theoretically relieve loading from the most commonly affected region of the joint. It seems simple, almost too simple.

But the truth is, it’s more complex. Here’s everything you need to know about lateral wedge insoles, the evidence, safe usage, and how they compare to other treatments.

Lateral Shoe Wedging for Knee Osteoarthritis Basics

Lateral wedge insoles are shoe insoles that are thicker on the outer edge of your foot than on the inside, and decrease in thickness as they cross over to the inside of the foot. The insoles are inserted into normal shoes, causing the foot to tilt into a slight everted position – where the sole of the foot tilts outward. The insole is intended for use by people with the most common type of knee osteoarthritis, which affects the inside of the knee joint (called medial compartment knee osteoarthritis).

The theory is that tilting the foot out slightly changes the forces that travel up the leg when you walk.

How Lateral Wedges Affect Knee Mechanics

To cut a long story short, the primary mechanical aim is to decrease the force called the knee adduction moment, that is measured in the lab as an indication of the extent to which the weight of your body goes through the inside of your knee with each step. As you would expect, it turns out that lateral wedges have been shown in the lab to slightly decrease this force, generally by about 5-10%. That sounds good.

Who May Be a Candidate?

Perhaps the most popular targets for this treatment are those who have been diagnosed with medial compartment OA, especially those earlier on in their disease progression. However, we know from previous research and the knowledge base that each person’s anatomy, walking style, and limb alignment all play a role on whether this technology will actually be helpful. If a person has a large bowing (beyond 3 degrees), they will probably not have the same response as someone who has a mild bow.

Research on Lateral Shoe Wedging for Osteoarthritis

The clinical data on lateral wedge insoles has grown substantially over the last 20 years. The reality that has emerged is both disappointing and has changed as the quality of trial data has become more rigorous. Lateral wedges have proven to be no more effective than flat insoles or shoe inserts for significant clinical outcomes in the general population of patients.

Effects on Pain and Function

Most more modern high quality evidence has shown almost no statistically significant improvement in pain scores or physical function compared with control insoles. A Cochrane review of the use of wedged insoles for medial knee OA found no convincing evidence of benefit for pain, stiffness or disability outcomes. There are individual patients who do subjectively experience a small improvement and a few subgroups, perhaps those with specific alignment profiles, may respond better.

But on average in study populations the effect is modest and variable. And that, is not a reason to throw these things out altogether.

Biomechanical Effects Versus Clinical Outcomes

The disconnect between biomechanics and clinical outcomes has always been a problem in musculoskeletal research. (And reducing an adduction moment in a research setting is, in fact, easy to measure and repeat). But how much reduction will be enough, and for how long and in what way, to actually protect cartilage and offer pain relief in everyday life — these are tougher questions. Long-term structural data (imaging of joint space or cartilage volume over time) is still sparse, and assertions that the intervention slows disease are not yet supported by the evidence.

Potential Benefits, Limitations, and Risks

Lateral wedges, in spite of the small clinical evidence, are relatively low risk and virtually costless in comparison to many other interventions. For some people, even a small decrease in pain while walking can be extremely important. And, as non-invasive methods, they do not rule out the use of others.

Nonetheless, limitations and potential disadvantages should be fairly acknowledged.

Comfort, Foot Symptoms, and Adaptation

Fit counts a lot. A large, ill-fitting, or otherwise inappropriate insole can generate pressure spots, force undesirable gait patterns, and can be so uncomfortable that the wearer abandons it. Several anecdotal reports from initial-week users have experienced greater outer ankle, outer knee, or foot arch discomfort – again, often due to altered load distribution across the lower limb.

Persistent discomfort beyond two to four weeks of gradual adaptation is definitely a red flag to be raised with a clinician.

Why Results Differ Between Individuals

Wedge angle, shoe type, initial gait mechanics, as well as where and how much joint damage exists can all impact effectiveness. The same 5-degree wedge shoe worn in a soft flat shoe differs from that same wedge in a better heel-to-toe walking shoe. And if the patient is pronated or flattened foot already, the wedge device may work in concert with altered lower-limb mechanics in ways that are impossible to predict without testing.

This, plus individual variations in data that averages out in groups, explains why testing under supervision and tracking every step (pun intended) can be very smart.

How to Use Lateral Wedges Safely

Beginning with an assessment by a healthcare professional is always the most prudent approach. The clinician can verify if the suspected osteoarthritis compa rtment is involved, as well as determine the degree of the misalignment, gait, the suggested degree of wedge (generally 5-10 degrees), and an appropriate shoe that will not interfere with the wedge. Over the counter generic shoe insoles purchased at a pharmacy may help, but they’re not designed for the individual shape of the foot or gait.

Choosing and Fitting an Insole

If the device is well-matched to the shoe it is in, with proper depth and a solid sole, it will work better than if same device is stuffed into a narrow or a soft shoe. The shoe influences the way forces are transmitted. The rocker bottom shoe, for example, interfaces with wedge insoles in a way that either magnifies or diminishes their benefit.

Proper fitting (preferably by a podiatrist or orthopedist) minimizes trial and error.

Monitoring Response and Warning Signs

Six to eight weeks of tracking symptoms is enough time to assess benefit. Use a pain diary to chart activity level, shoes worn, and comfort. Discontinue use and consult your health professional if your balance is affected, if you develop a new knee, ankle, or hip pain, or if your symptoms become worse rather than better.

Alternatives and Shared Treatment Planning

Lateral wedge insoles are most effective when part of a multi-modal treatment plan and not a complete solution. Knee osteoarthritis can be managed with a multi-modal approach and there is substantial evidence for a number of non-operative options.

Evidence-Based Non-Surgical Options

In terms of evidence strongest evidence for conservative management of knee OA is on exercise therapy (specifically strengthening quadriceps and hip abductors). Weight loss (if indicated) is arguably more effective at decreasing load on the joint than any insole design. Education, activity modification, and analgesia are beneficial to help manage symptoms.

Knee bracing, and particularly a valgus unloading brace is likely to provide more consistent biomechanical corrections than a wedge insole.

Questions to Ask a Healthcare Professional

Before you try a wedging device, it’s worth asking your doctor or therapist a few questions, such as: What is the worst-affected compartment?

How likely is a wedge to suit me given my alignment?

What wedge angle and footwear combination would work with my gait?

How long should I be tested for and what change would be considered a success?

Are there other options, such as an exercise program or a brace, that might be preferable?

These discussions can help guide more realistic expectations and avoid fruitless efforts.

Lunge Test for Ankle Joint: A Practical Guide

You’d probably never think about your ankle until it stopped moving one day. A tight ankle can subtly mess with your squat, influence your gait, and in the long-term even cause pain in your knees or hips. The Lunge Test for ankle joint mobility is a straightforward, well-established way to check how much your ankle moves – in the direction it needs to for daily life.

This post covers what the test measures, how to do it, interpret the results, and know when you need professional help.

What Is the Lunge Test for Ankle Joint?

What is the weight-bearing lunge test?

The weight bearing lunge test is also referred to as the knee-to-wall test and is a way to measure closed chain ankle dorsiflexion range of motion. This test is performed while standing as opposed to lying down and better demonstrates ankle mobility during movement. This test is common practice among physiotherapists, sports medicine doctors, and strength coaches because it’s easy to perform, repeatable, and inexpensive.

What the Test Measures

Your ankle bends in the opposite direction, toward your shin, during a movement called dorsiflexion. In the lunge test, your tibia (shin bone) is supposed to slide forward over your stationary, flat foot. The space between the big toe and the wall when your knee is barely touching that wall is an indication of how far and how well you’re able to dorsiflex (higher lunge = more dorsiflexion, shorter distance, less dorsiflexion).

Of course, if the heel isn’t flat, you’re kinda cheat’n…because you’re flexing at the hip and bending your knee instead.

Why Ankle Dorsiflexion Matters

Limited dorsiflexion affects everything downstream. During squat, stair climbing or running uphill, the tibia needs to move forward quite a bit to bring the rest of the foot and ankle along. If the ankle doesn’t move to meet that demand, the rest of the lower limb has to make up for it by way of heel lift, knee collapse, or heel lift plus knee collapse, heel lift plus lower back round, or some combination of all three.

Lack of ankle mobility creates dysfunctional overcompensation patterns that can lead to overuse injuries in the knees, hips, and plantar fascia.

How to Perform Lunge Test for Ankle Joint

The setup is simple, requiring only a wall, a tape measure and some space on the ground. Stand facing a wall, with one foot pointing straight ahead (as if aiming your toes at the base of the wall). The trick is to be consistent – use the same foot position, starting point, and tracking for your knees every time and for each side.

Starting Position and Setup

Position your test foot a few centimetres away from the wall with your toes pointing forward (not turned out to the side). Fan knee forward toward the wall maintaining tracking over second toe (don’t let it cave in or drift out). Keep body upright (do not lean over the front foot to shift weight), behind foot resting comfortably in a split stance.

Finding the Maximum Distance

Begin close enough to the wall that your knee can rest against it, then take the foot back a few centimeters – an inch at a time. Try to get the knee to touch the wall without ever raising your heel from the ground. Keep going back until you can’t quite get the knee to touch the wall and still keep the heel on the ground – this distance is your result.

If you raised your heel before your knee hit the wall, you didn’t get a score.

How to Measure and Record Results

Now you know the furthest range, mark a measurement on the wall in centimetres from the tip of the longest big toe to the wall. Take 2 or 3 measurements from each side and average the results. Remember to test both ankles – symmetrical data can often be more meaningful than a single number in isolation.

Distance and Angle Measurements

The most common unit of measurement used by clinicians is the cm distance. One measurement widely suggested is around 10cm (though others contend this is different for each activity and individual) however the function needed for each activity can be different, so take care when comparing to measurements on this list. You may also see some using an inclinometer on the shin to measure the angle of the tibia at its furthest point of dorsiflexion.

This adds a degree of accuracy, however adds a cost for the inclinometer. For the purposes of running around the house, the tape measure method is perfectly fine and easy to do.

Standardizing the Test

Repeatability counts. But always try to do the test barefoot, or in the same pair of shoes. If you warm up lightly – five minutes of slow walking or cycling, for example – you will eliminate the stiffness, and get an accurate measurement.

If you feel pain while moving, note where on your body it is, and don’t forget other compensatory actions, such as pronation or rotation of the hip, as these will influence the distance travelled and are not representative of ankle function.

Interpreting Lunge Test for Ankle Joint Results

No one size fits all cutoff. It depends on the person – a recreationally active walker will be very different from a competitive weightlifter or Crossfitter in terms of how much movement that toe-to-wall distance accounts for. However, most movement experts would view a toe-to-wall distance of less than 10 cm as limiting for squatting and running.

Comparing Left and Right Ankles

You know what matters more than the numbers?

The side-to-side difference. If you notice a difference of more than 1.5cm (0.6 inches) when comparing one ankle to the other, that could mean you have a mobility difference to tackle, especially if you’re an athlete or have previously sustained an ankle sprain. Chronic sprains can result in scarring and ankle restrictions that decrease mobility on the injured side – and the lunge test can pick up on these disparities.

Recognizing Compensations

Pay attention to heel lift, excessive foot pronation, knee valgus (caving inward), or trunk lean. These compensatory motions indicate the body is circumventing the ankle instead of using it. When this is the case, the measured distance exceeds the true dorsiflexion range of motion, potentially giving the appearance of a stronger ankle than is actually present.

Limitations, Safety, and When to Seek Help

The lunge test is thorough and statistically sound, but not perfect. Technique, foot placement, and body structure can influence readings. It provides measurements for range of motion only and does not evaluate strength, nerve, and joint health.

Common Testing Errors

Common errors consist of failing to maintain foot position uniformly in between takes, instead letting the knee push inward. Measuring from the wrong point on the toe. Requiring the knee forward into pain can skew the metric, and also putting a spot like ligament tissue in pain can exacerbate an injury.

Movement and also pain are two separate discoveries – both matter, yet erroneously combining them results in mistaken judgment.

Low Dye Strapping Foot: Technique, Benefits, and Safety

Foot pain can disrupt our day – a few steps in the morning and everything feels more difficult. For the often chronic pain of plantar fasciitis, flat feet or who struggle with arch pain, Low Dye strapping foot technique provides a simple, drug free treatment strategy. If you haven’t come across Low Dye strapping foot before, the technique has been utilized by podiatrists, physiotherapists and sports medicine clinicians for many years and for good reason – the taping technique provides an external mechanical arch support and limits the problem foot mechanics.

What Is Low Dye Strapping Foot?

What is Low Dye Strapping?

The Low Dye taping technique is an athletic taping method that provides a rigid support to the medial longitudinal arch – the curve along the bottom of your foot on the inside edge. Developed by Ralph Dye in the early part of the 20th century, it consists of parallel, overlapping strips of non-elastic tape to restrict excess foot motion and diminish the strain on soft tissue structures. Traditionally, it is a short-term management technique for various foot and heel conditions, providing mechanical support without the bulk of an orthotic.

How It Works

Tape prevents too much pronation (bottom-inward roll of the foot that commonly causes arch and heel pain). The tape prevents excessive pronation which allows you to alter how the pressure is spread across your foot when you walk or stand. This in turn alleviates pressure on the plantar fascia (the thick connective tissue along the bottom of the foot) and so will lessen your pain along the sole of your foot, due to its anti-inflammatory actions.

The tape does not do this in a therapeutic way to cause healing of tissue, but more mechanically by keeping the foot in a more neutral position.

Low Dye Strapping vs. Other Foot Taping Methods

Standard Low Dye strapping utilises rigid, non-elastic zinc oxide tape that can be quite different to the kinesiology tape (such as Rock Tape or KT Tape) that we are used to seeing in the sporting field. Kinesiology tape is elastic and some of the strapping occurs by creating space between the skin and the superficial tissues increasing circulation and sensory feedback. Standard arch taping in this situation might simply be a few transverse strips without the full anchoring system and structure of traditional Low Dye.

When Is Low Dye Strapping Foot Used?

What is it good for?

Usually, a clinician will suggest this as short-term support, especially if someone is in pain and needs relief while they work out a more comprehensive treatment plan. It’s not a cure. But it can take the pressure off enough so you can move and do your daily activities with less pain.

Think of it as a frame for a building.

Plantar Fasciitis and Plantar Heel Pain

You’re probably here because you want to know about the most common use of Low Dye strapping – Plantar Fasciitis. You might think of it as the ” heel-strangulation,” because it’s a no-fun cause of a painful plantar fascia that takes the form of a pinched sensation in the heel. Strapping the structure absorbs some of the tensile stress during weight bearing, which can effectively soothe the condition.

A handful of recent research studies have affirmed that for plantar heel pain.

Flat Feet, Overpronation, and Arch Support

Individuals who have the medical condition pes planus or excessive overpronation tend to have arches that collapse excessively under body weight and over time, cause stress to muscles, tendons, and ligaments. The Low Dye tape strips mimic the inability to support the arch that is lost and provides some control of inward foot motion and fatigue; it also is a very good diagnostic test – if they are vastly improved with the taping, then there is a good chance that a typical orthotic will have long term benefits.

How to Apply Low Dye Strapping Foot

You have to get it right – bad taping will make it worse: problem areas or even new issues like pressure points, skin irritation, or just not providing the level of support expected which can be dangerous. Clean and dry the foot before taping. Shaving the foot makes the tape stick well and removes pain when removing.

A skin adherent spray or prewrap can help.

Step-by-Step Application

Here’s the general sequence used in clinical practice:

  1. Apply two anchor strips — one around the ball of the foot, one around the heel
  2. Run a series of arch-support strips from the anchor at the ball of the foot, under the heel, pulling upward to create medial arch lift
  3. Add transverse strips across the plantar surface to lock the arch strips in place
  4. Finish with closing strips along the sides of the foot to secure everything

The strips are overlapping each other by a little, and the tension is great but not tight.

Materials and Positioning

Use rigid zinc oxide tape (standard width 38mm). Have your patient sit, and with the ankle at 90 degrees – the ankle should be in a neutral position – not plantarflexed. Slightly roll the foot outward (supinate it) before taping, as this is the position the tape is meant to maintain.

Safety, Aftercare, and Common Mistakes

Typically, there are no major risks with Low Dye strapping, but you will need to remove the tape after three to five days and watch the skin for any adverse reaction.

Warning Signs and Contraindications

Remove the tape immediately if you notice:

  • Persistent itching, redness, or rash
  • Numbness or tingling in the toes
  • Skin blistering or breakdown
  • Any change in circulation (toes becoming cold or discolored)

This technique should not be used on people with diabetes, peripheral vascular disease, delicate skin, skin that is sensitive to certain materials, open wounds or individuals who are allergic to tape unless monitored by a clinician.

Application Errors to Avoid

Common mistakes that reduce effectiveness or cause harm include:

  • Applying tape with excessive tension, cutting off circulation
  • Leaving wrinkles in the tape, which create pressure hotspots
  • Taping directly over broken or irritated skin
  • Failing to anchor strips properly, causing the whole application to shift

When to Seek Professional Assessment

If your foot pain, swelling that won’t go away, tingling or a feeling of numbness, or even an abnormal way of walking, then you need a professional assessment. A podiatrist will be able to pinpoint the exact cause of your foot pain, and whether Low Dye strapping is the best course of action – or not.

Combining Strapping With Treatment

Strapping is most effective when used as part of a comprehensive plan. Common complementary treatments include:

  • Supportive footwear with adequate arch structure
  • Calf and plantar fascia stretching exercises
  • Custom or prefabricated orthotic devices
  • Load management and activity modification
  • Targeted strengthening for foot and lower limb muscles

Low Dye strapping foot support is a long established evidence based technique that can genuinely reduce pain levels in plantar fasciopathy, flat foot and related conditions. If applied well it will help short term by constraining the foot and offloading the irritated tissue. But it is only a bridge to return over, and if you only use tape without correcting the actual cause of the problem, you won’t get good long term results.

If you’re going to try this technique, ensure you see a podiatrist or physiotherapist to confirm the diagnosis and check the tape is being put on well. Used as a temporary adjunct to treatment it can be very helpful.

LisFranc Fracture: Symptoms, Diagnosis, and Treatment

A simple looking injury can hide a complex one With that in mind, the LisFranc fracture is a prime example – often written off as a simple sprain, it can lead to chronic pain and disability if left untreated. The name of the injury comes from the French surgeon (and scientist) Jacques Lis Franc de St. Martin, who described injuries to the midfoot (tarsometatarsal joints) in the early 1800s.

In this article, you’ll learn what exactly a LisFranc fracture is, how it occurs, the signs and symptoms, and the modern day treatment. Thankfully, being able to identify the signs could mean faster diagnosis and treatment.

What Is a LisFranc Fracture?

The Lis Franc joint is located in the middle of the foot where the tarsal bones meet the five metatarsal bones that run towards the toes. A LisFranc fracture is any damage – broken bones, torn ligaments, or both combined – in this area. It is a common misconception that it is always a simple break in the bones.

LisFranc Injury Types

Clinicians generally categorize these injuries into three groups:

  • Ligament-only injuries — No bone breaks, but the stabilizing ligaments holding the midfoot together are stretched or torn
  • Fractures — One or more bones in the tarsometatarsal region break without significant joint displacement
  • Fracture-dislocations — The most severe type, involving broken bones and displaced joints simultaneously

A low impact event, such as stepping off a curb or stairs the wrong way, can also cause injury to the ligament. The higher impact trauma – a car accident, falling from height – leads to the more complex fracture dislocation.

Why It Is Often Missed

The anatomy of the midfoot is complex and tight – this makes standard weightbearing films difficult to interpret, with a lot of overlapping joint spaces and mini Bones, and minimal alterations in the normal “line-up”. Even what appears to be a innocuous film can hide a real instability. Research has indicated that 20% of Lis Franc injuries initially missed and only diagnosed as Sprains, and this can seriously change a poorer prognosis.

Swelling and pain that appear “behavioural” after a twist can really be something more sinister underneath.

Causes and Symptoms of LisFranc Fracture

Know what makes this injury happen will help to reason why it could occur with such a wide range of people including a professional athlete to someone who just miscalculated a step.

Common Causes

Several distinct mechanisms can produce a LisFranc injury:

  • Sports injuries — Football, soccer, equestrian sports, and gymnastics carry elevated risk, particularly when a planted foot gets twisted or stepped on
  • Falls — Landing awkwardly from height places enormous stress on the midfoot
  • Vehicle collisions — Direct crush force during car accidents can devastate the joint complex
  • Crush injuries — Heavy objects falling onto the foot create direct trauma
  • Twisting events — Something as simple as catching a foot in a hole while walking can generate enough rotational force to tear ligaments

The common theme here is also a force on a partially planted foot, which causes unwanted stress on the tarsometatarsal joints.

Key Warning Signs

If you notice any of the following early symptoms, seek medical attention:

  • Significant midfoot pain, especially when pressing on the top of the foot
  • Swelling across the midfoot that develops quickly after injury
  • Bruising on the sole of the foot — this is a particularly telling sign, often described as plantar ecchymosis
  • Tenderness when pressing along the tarsometatarsal joint line
  • Difficulty or complete inability to bear weight on the affected foot
  • Pain that spikes sharply during push-off when walking or running

Plantar bruising is one example of a red flag, where imaging might be recommended even if the pain is not.

How a LisFranc Fracture Is Diagnosed

Diagnosis involves both a clinical exam and imaging in a targeted search. There is no one diagnostic test that provides a clear answer – diagnosis involves a mosaic of data from a variety of sources.

Physical Examination

A clinician will assess the foot systematically, looking for:

  • Point tenderness along the tarsometatarsal joints
  • Plantar bruising, which strongly suggests ligament disruption
  • Visible deformity or abnormal foot alignment
  • Signs of instability when the forefoot is gently stressed

Very important note; if this injury occurred, do not self-test on your own at home. Any tenderness to even touch of the problematic midfoot can only exacerbate the displacement. This is a job for the trained professionals.

Imaging Tests

Imaging is critical and modality is based on severity of injury:

  • Weight-bearing X-rays — The starting point; diastasis (widening) between the first and second metatarsal bases greater than 2mm is a key diagnostic marker
  • CT scans — Superior for identifying small fractures, assessing joint alignment, and planning surgery when needed
  • MRI — Most useful for evaluating ligament integrity in cases where X-rays appear normal but symptoms remain significant

Occasionally, when a stress X-ray study under local anesthesia can demonstrated instability not seen on more routine views.

LisFranc Fracture Treatment and Recovery

Treatment very much depends on whether or not the joints are stable and whether they are aligned correctly. There is no single treatment plan to follow.

Nonsurgical Treatment

Longstanding non-moved injuries – where the bones and joints still line up – may be treated without surgery:

  • Complete non-weight-bearing in a cast or boot for six to eight weeks
  • Regular elevation to control swelling, especially in the first week
  • Follow-up imaging to confirm the injury hasn’t shifted
  • Gradual progression to protected weight-bearing as healing advances
  • Physical therapy focusing on strength, balance, and gait retraining

Surgical Treatment

If they become dislocated or are unstable, they will need to be operated on. These include:

  • Open reduction and internal fixation (ORIF) — Realigning bones and securing them with screws or plates
  • Midfoot fusion — In severe cases or when post-traumatic arthritis develops, permanently fusing the affected joints may provide the most reliable pain relief

Any surgical procedure needs to be assessed and evaluated by a foot and ankle orthopedic surgeon.

Recovery Timeline

Recovery from the Lis Franc injury is much slower than most people expect – in fact:

  • Weeks 1-8: Immobilization and strict non-weight-bearing
  • Weeks 8-16: Gradual protected weight-bearing with physical therapy
  • Months 4-12: Return to low-impact activity, supportive footwear, continued strengthening
  • Full return to sport or demanding physical activity often takes 12 months or more

Complications, Prevention, and When to Seek Care

Lis Franc injuries are not just “one-and-done” even if treated.

Possible Complications

  • Chronic midfoot pain that persists beyond expected healing time
  • Post-traumatic arthritis — probably the most common long-term issue
  • Reduced range of motion and stiffness in the midfoot
  • Recurrent instability, particularly after ligament-only injuries
  • Nerve-related symptoms including numbness or tingling
  • Hardware irritation requiring removal after surgical fixation

When to Get Medical Attention

Certain situations demand urgent evaluation — don’t wait:

  • Severe midfoot pain following any fall, collision, or twisting injury
  • Visible plantar bruising after foot trauma
  • Marked swelling that develops within hours of injury
  • Complete inability to bear weight
  • Any obvious foot deformity
  • Symptoms that worsen rather than improve after 24-48 hours

A LisFranc fracture is honestly one of the most underdiagnosed injuries of the foot that we see in practice and the implications of missing it are devastating. The earlier you can pick it up – the plantar bruising, the persistent pain, midfoot pain and pain with weight bearing – the better your prognosis will be. Early imaging with weight bearing X-ray, CT scan or MRI will give your medical team everything you need.

Patience is what is required both if the Management is with immobilization or with surgery, the recovery period requires patience. Excess haste in rehab or early resumed activity can cause dislocation, persistent pain, and accelerated arthritis. Work with your foot and ankle specialist, and adhere to imaging follow-up schedules, and believe in the timeline for recovery as set forth by your doctor.

Most persons eventually return to significant function.

Lace Bite in Ice Skates: Causes, Relief, and Prevention

Remember – when you hit the ice it should be fun, not painful. But for most ice skaters (even those who have been doing it for decades) a stabbing, stinging sensation in the front of the ankle can transform a perfect day into a terrible one. That’s lace bite in ice skates, and it happens much more often than you think.

The pain is not a mystery – there’s a mechanical issue between your body and your boot. And figuring out what’s really happening below the tongue of your skate is the key to solving the problem – and preventing it from happening again.

What Is Lace Bite in Ice Skates?

What is Lace Bite?

Lace bite in ice skates is a soft-tissue irritation, happening along the front of the ankle, where the tongue and laces are pushing against tendons which run just below the surface of the skin. Unlike blisters, which happen when the outermost layers of skin are worn away by friction, or pressure points, which develop from a poorly fitted boot, lace bite involves structures much deeper below the surface. In fact, the tibialis anterior tendon, along with the extensor tendons of the toes, is located right under the surface in this region and suffers from repeated compressive force.

Common Symptoms

The classic symptom of an inflamed ankle extensor tendon is a stabbing or aching pain right at the front of the ankle, often localized to a small “pencil-eraser-sized” area. Tenderness to the touch is the norm, and many skaters experience mild swelling or redness at the front of the ankle once the boot has been removed. Stiffness in the ankle during the first few strides of the session, or moderate to severe pain with ankle extension when the time comes to do it, are other classic signs.

If the pain doesn’t settle down when a session ends and you notice that it’s beginning to interfere with your ability to walk, the problem has progressed.

Who Is Most at Risk?

A new skater in stiff boots is a higher-risk scenario, but even an experienced skater who has recently bought a new model or brand may be at higher risk. Those with high insteps are more prone because the shape of the foot naturally applies greater force to the tongue. Unsuitable skate volume that pushes more force to one spot can also cause problems.

Even a change in skating pattern – starting daily skating for example, when you’re used to skating just once a week – can cause lace bite in a well-fitting skate, just because the tendons need time to build strength.

What Causes Lace Bite in Ice Skates?

Lace bite in ice skates has a simple mechanism. With each stride you take and ankle flex you make, the tongue of the boot pushes up into the tendons just below the ankle. Do that hundreds of times in a single skate, and you’ll have created some pretty significant pressure.

The tibialis anterior and extensor tendons are compressed in a tight space with precious little between them and the boot lining, so even moderate compression that goes on for a while can be painful.

The Role of Skate Fit and Tongue Stiffness

A boot that lacks adequate instep volume is essentially crushing the tendon area as soon as you slide into the boot. Very stiff tongues – especially those found in new, high-performance skates, don’t contour to the shape of an individual foot, so the pain is caused by the sharp edges of the tongue’s forge instead of an even distribution of pressure throughout the shoe. The padding in a tongue can compress over time and lose some of its ability to cushion the laces.

In addition, skates that fit too narrowly at the forefoot push the foot forward slightly and change the way the tongue rides and inevitably send more pressure onto the tendon.

Lacing Mistakes and Skating Habits

Over-tightening is likely the most common culprit of all. Strangling the laces as tight as you can makes you feel tight and supported, but also pounds that tongue hard into the tendon with every stride. Skipping straight across the eyelet that sits over the ankle crease is another common error – forget that eyelet and go above it – it really can make a difference.

Skaters that don’t warm up before they start skating also run into problems – cold, tight tendons don’t tolerate compression as well as warm one. And anything that causes more skating than you are used to – tripling your practice hours during a tournament week, for example – may be a contributing factor.

How to Relieve Lace Bite

In general, total time off the skate is not necessary for recovery from lace bite, but intentional modifications in how the skate is used are. The goal is to offload the stressed tendon with enough rest to settle the tissue down. The idea of skating through increasing pain to get to the other side is counterproductive – this strategy prolongs recovery by 3-4X and can lead to a chronic condition.

Adjust the Lacing Pattern

Bunions: loosen the top 2-3 eyelets around your ankle, and leave those top 2-3 eyelets undone while lacing. Don’t completely eliminate ankle support, but these holes apply less compression to the tendon. The “better” fix: skip the eyelet over the pain, which will leave a tiny pressure gap over the injured part of the tendon, then continue lacing as normal.

Some skaters replace the laces with wax-coated ones, which do not tighten as much to maintain the same amount of tension, if you haven’t tried this already.

Use Padding and Cold Therapy

Lace-bite pads – thin, donut-shaped foam or gel cushions worn on the tendon underneath laces – are available specifically for this, and they do help a lot of skaters. Broader gel sleeves encasing the ankle can give more protection. One word of warning: Padding inside the boot shouldn’t be so tight that it creates additional soreness elsewhere.

Inflammation can be treated with short applications of cold after skating (10-15 minutes) without the potentially dangerous pitfalls of ice long-term. Anti-inflammatory treatments are a temporary adjunct to equipment alterations, not a replacement for them.

How to Prevent Lace Bite in Ice Skates

In the end there are two things to remember when it comes to prevention: get the equipment right, and give the body time to adapt. Neither is terribly complex, but both do require some patience.

Improve Skate Fit and Break-In

Good fit, by a competent skate shop, is very worthwhile. Fitters factor in instep height and width and volume which online sizing charts miss out. Check if the boot offers heat molding, which involves the boot being warmed so that it can be formed to the shape of a specific foot, and thus be much more comfortable with fewer hotspots.

If starting out with a new model, a gradual breaking in strategy of shorter sessions initially and longer sessions after a week or two, helps the tongue and sole adapt to the foot. Exchange the tongue paddings if flattened or lopsided.

Build Better Skating Habits

And before getting into all the technical stuff: Warm up properly by doing ankle circles, light flexion, etc. Increasing your volume slowly (as a very general rule of thumb, not more than approximately 10% per week) allows your soft tissues to adapt to the increased load. Regularly inspect your blades; misaligned blades slightly change how your skating mechanics work and over time can change where you load stress onto your tendons.

When you first notice pain, take a break and check your lacing tension before it gets really painful.

When to See a Doctor or Skate-Fitting Professional

Most cases of lace bite go away with the right changes to your skates and your load. But there are some common signs that you should have a health care provider take a look. If you are in pain long after you leave the ice, if you get numbness or tingling along the top of your foot, if you notice the tendons along the top of your foot look thicker, or if you have difficulty lifting your toes, there’s more to it than irritation.

If your pain is keeping you from walking normally (not skating) for more than 2 weeks, a sports medicine doctor or physical therapist can decide if tendinopathy has occurred and take steps to fix it.

Kohlers Disease of the Navicular: Symptoms and Treatment

Suddenly, your child is limping, suddenly complains of foot pain after a day at school, or refuses to bear weight… And there’s no trauma to explain the limp. That’s a parent’s nightmare, but there’s a condition that can cause exactly that picture and not be all that rare: Kohlers Disease of the navicular.

Here’s what it actually is, how to recognize it, how physicians make the diagnosis, what causes it, and how kids are usually managed. The best part?

The patient outcomes are very good.

Understanding Kohlers Disease of the Navicular

What is Kohler’s Disease?

A Rare Pediatric Bone Disorder that Affects the Navicular KOHLER’S DISEASE AFFECTS the navicular – the small, boat-shaped bone on the medial side of the midfoot. It actually serves an important function as it is a keystone in the arch of the foot, and if it’s affected, it is uncomfortable to walk and disturbs the normal foot mechanics. Here’s what’s going on inside that bone to cause the problem.

Definition and Cause

Kohler’s disease is a form of osteochondrosis, a general term for temporary interruption of blood flow to an immature bone. In the absence of blood flow, the navicular has a case of avascular necrosis, and the bone substance begins to deteriorate because it isn’t getting the oxygen and nutrients required to survive. Thankfully, children’s bodies are excellent at repairing themselves when subjected to this sort of insult.

Once the blood flow begins again, the avascular necrosis is resolved, and the bone rebuilds itself.

Who Gets It

If you have a very active child or children who spend most of their time on their feet then they are more likely to feel the symptoms while they are even more mechanically loaded by weight bearing stresses.

Symptoms and Early Signs

Even before a formal diagnosis is made, parents can tell that something is different with their child. Perhaps the child has a limp when walking or refuses to put weight on one foot when walking. Or the child might complain of pain in a very specific area.

These early signs are important to recognize, as the sooner the condition is diagnosed, the sooner you can start to manage and help it.

Foot Pain and Limping

Pain in the midinner of the foot, over the navicular bone. Most children complain of it as an ache that gets worse with activity and better with rest.

    Nearly always you will be able to press on the navicular bone in the centre of the foot and that will be tender. Midfoot swelling is common. Affected children may walk with a limp, and younger children may be reluctant to walk or ask to be carried more than normal.

    The pain is not severe or crippling but it is persistent and affects the way the child walks.

    Visible Changes and Activity Limitations

    Other clues to give you a hint towards diagnosis: You may see little to no redness or warmth at the navicular bone. This is not always there, but easy to miss. The test that really indicates diagnosis – children will walk on the edge of their foot – they shift their weight away from the pain and this may lead to later problems with their ankles or knees if it persists for months.

    It is noticeable because they are limping and avoid activity – running, jumping and long walks for example – cause pain.

    How It Is Diagnosed

    Making the diagnosis involves excluding other potential causes of midfoot pain such as fracture, infection and inflammatory disease. Once the diagnosis is suspected, it is fairly simple to make a confident diagnosis using a combination of clinical examination and imaging.

    Physical Exam and History

    History is the key. The doctor will want to know when pain started, was there an injury, does it hinder walking, and does rest help. On examination, tenderness directly over the navicular is a significant feature.

    The doctor will also watch how your child walks, noting if they have the well-known weight-shifting style. Because Kohler’s disease has no laboratory test to confirm its presence, diagnosis hinges on clinical findings and X-ray pictures.

    X-Rays and Imaging Findings

    The initial imaging investigation will be plain X-rays. With Kohler’s disease, the navicular bone will look more dense (sclerotic), flattened and fragmented, similar to how it looks on the opposite side but more compressed, and misshapen. This combined with the child’s age, level of pain and whether they have other pain or symptoms around the foot, is normally enough to confirm the diagnosis.

    An MRI scan is sometimes ordered where the X-ray features are less clear and there’s a clinical question over the marrow changes seen, but not normally needed.

    Causes, Risk Factors, and Prognosis

    What causes Kohler’s disease isn’t known for sure, but various overlapping theories of navicular etiology in childhood have been proposed.

    Possible Mechanisms

    The navicular turns into bone – a process called ossification – after many other bones in the foot, and so it’s weaker at a stage of development when it’s likely to be subject to repeated crushing forces when walking and running. Its blood supply is far from secure and strong, and some have highlighted delayed ossification as the key risk factor while others maintain that low and erratic blood circulation makes the navicular uniquely exposed and vulnerable.

    Recovery and Long-Term Outlook

    The outlook is really good. The majority of kids will be back to normal in 2-3 years and the navicular will be normal shape and density on follow-up Xrays. Long term studies demonstrate no significant increase in arthritis or other functional problems as an adult, so that is good news for parents to hear.

    Treating Kohlers Disease of the Navicular

    While management aims to decrease pain and protect the foot during the natural healing process of the bone, there is no available treatment that increases the speed of this healing process. The aim is to maintain function and comfort of the child.

    Rest, Support, and Pain Relief

    Medical Treatment of Navicular Stress Fractures Nonsteroidal anti-inflammatory medication, such as ibuprofen, can help with pain and swelling. Activity modification – Limit high-impact activities as tolerated until symptoms resolve. Proper footwear -Supportive footwear with good arch support or orthotic devices can reduce the pressure on the navicular and significantly improve walking comfort.

    Cast – A short-leg walking cast for 6-8 weeks (immobilization) will give the bone a period of rest and can diminish pain and improve the ability to walk.

    When Medical Evaluation Matters

    They require rest with elevation for at least two weeks. If, however, the child refuses to walk, can’t put weight on the foot at all, has marked swelling or the pain persists despite initial rest and analgesia then a parent should arrange review with a doctor. A straightforward midfoot sprain can be diagnosed and managed easily in the short term by the pediatrician or a pediatric orthopedic surgeon and parents sleep better.