Foot and ankle pain - Sports Injury

KT tape for Achilles pain

by Pete Colagiuri - Sports Physiotherapist

Is KT tape for Achilles pain useful, or just a marketing trick?

If it’s useful, how do you apply KT Tape for Achilles pain?

Our Physiotherapy team share all their tips and tricks for using dynamic tape to help Achilles pain.

(If you’re looking for KT tape for calf pain, check out this post).

Firstly, what is KT tape?

KT tape is one brand of dynamic tape, a stretchy elastic tape designed to stick to skin.

The tape provides feedback to the brain on whether the joint or muscle is stretching.

That can be useful is the normal mechanism of feedback, from ligaments and muscles, is disrupted by an injury.

The tape doesn’t provide restriction to movement like rigid strapping tape.

So the unique qualities of dynamic tape could be best summed up as “movement feedback without restriction“.

Is KT tape for Achilles pain useful?

KT tape for Achilles pain can be hit and miss, although it’s more of a miss for most people.

This is because the tape only provides feedback on movement – it doesn’t actually support the Achilles tendon.

So KT tape for Achilles pain can be useful in cases when people aren’t aware of the level of stretch in the Achilles tendon during exercise.

This group are often the ones who can train well but get Achilles pain afterwards.

The tape can provide a reminder to not overstretch the tendon in the absence of pain.

For most people though, the pain is a great reminder to not push it too far so the tape wouldn’t help.

Other people with more severe and sensitive cases of Achilles tendinopathy actually need physical support of the Achilles.

This reduces the loads the Achilles is exposed to and can only be achieved with rigid tape, a brace or heel wedges.

How should you apply KT tape for Achilles pain?

When you apply any dynamic tape, remember that its job is to provide stretch feedback to the brain.

With that in mind, it has to be quite firm and noticeably tight in the target position.

Set up position

With KT tape for Achilles pain, you’ll need to know that the tendon is under pressure as soon as the foot moves past 90 degrees (standing position).

So it’s best applied with the foot in a plantarflexed (slightly pointed) position.

Tape application

You then apply the tape with only a mild pressure from 2″/5cm under the heel and up the Achilles tendon around 8-10″/20-25cm.

The next tape has the same pressure but runs slightly diagonally from one side of the previous tape’s start point to the other side of its end point.

That tape should cross the other tape near the base of the Achilles.

The slightly offset position is to maximise the tape’s contact with the skin (rather than having it pull on the other tape).

The 3rd tape is the mirror image of the 2nd tape, running diagonally in the opposite direction to maximise skin contact.

Now is the time to test the tape tension (try saying that quickly…)

The tape should noticeably tighten up as the foot moves past 90 degrees.

If not, remove and reapply the tape to refine the tension.

If it works as planned, move on to the most important step – anchor the tape.

Anchoring the tape

Any dynamic tape under tension tends to lift off the skin.

The anchor holds it in place to stop it lifting off and to help maintain its tension.

For this step, rigid strapping tape works best.

The anchor tape runs at right angles (perpendicular) to the dynamic tape.

Anchor the dynamic tape under the heel, just above the Achilles and at the top of the tape.

Don’t anchor across the painful part of the tendon as it hates compression from a firm anchor.

Is it normal to have a split Tibialis Posterior…

by Pete Colagiuri - Sports Physiotherapist

For every ankle MRI we order, it seems that a decent number of them are coming back with a split Tibialis Posterior tendon (also known as Posterior Tibialis tendon).

So it begs the question, is that the cause of pain or is a split Tibialis Posterior tendon a normal finding?

How common are traumatic Tibialis Posterior tendon tears?

It’s difficult to find much info on how often this tendon is injured in acute, or sudden, injuries.

One small study reported that around 1% of ankle sprains ended up with a Tibialis Posterior tendon tear.

How accurate are MRI and ultrasound at diagnosing split Tibialis Posterior tendons?

Interestingly, MRI and dynamic ultrasound have similar levels of accuracy for diagnosing Posterior Tibilais tendon splits.

MRI and dynamic (or in motion) ultrasounds will accurately diagnose a split Tibialis Posterior tendon in around 72% of cases.

Static (or stationary) ultrasound is still good but not quite as accurate.

Is inflammation around the Tibialis Posterior tendon a common MRI finding?

Short answer is yes – around 33% of ankle MRI will show some degree of inflammation around the Tibialis Posterior tendon.

More interesting though is the correlation to symptoms.

Of the 33% of MRIs with inflammation around the tendon, around 70% of those people don’t report any symptoms in the area.

So it appears that, while inflammation around Tibialis Posterior tendon is moderately common, it’s often not a cause of pain or symptoms.

Is a split Tibialis Posterior tendon normal?

From what we understand of anatomy and its variations, some people can be born with variations in tendon structure. But it’s not the majority of cases.

Others can develop splits in their tendon due to continuous loading, such as in marathon and distance runners.

That group is harder to quantify as there’s no studies on the topic.

The last group is the acute injuries – sudden tears of the Tibialis Posterior tendon.

As we reprted above, this group makes up less than 1% of all ankle sprains. So they’re not common either.

Does a split Tibialis Posterior tendon cause pain?

We know that inflammation around the tendon is common (33% of cases), yet symptoms associated with the inflammation are less common (pain reported in less than one third of cases.)

We also know that for a split tendon to be reacting, it will most commonly produce some sort of inflammatory response.

So a split tendon without inflammation is unlikely to be the cause of any symptoms.

11 best running shoes for bunions

by Pete Colagiuri - Sports Physiotherapist

Finding the best running shoes for bunions can be a challenge at the best of times.

There are number of issues to consider including the additional width of the foot because of the bunion.

But the good news is the best running shoes for bunions do exist and you can find them.

Skip straight to our recommendations or read on for information about how to select the perfect shoe for you.

Key features

When searching for the best running shoes for bunions, the main feature that you require is obviously the width of the shoe to accommodate the angulation of the big toe.

Without the additional width, there is pressure on the sides of the toes.

And if the bunion overlaps the edge of the shoe, it creates foot/ankle instability that can directly to injury.

The second, less obvious feature required is stability in the shoe.

Bunions are caused by a prolonged history of uncontrolled pronation.

The reason bunions tend to accelerate their progress over time is that, as the toe angles, it becomes less effective at stabilizing the foot and creates even more uncontrolled pronation.

After those two features have been considered, you can then select your personal preference for heel-toe offset and stack height (aka. the amount of cushioning).

Finding the right width

Male running shoes come in a standard “D” width.

(Female standard width is a “B” width – we’ve got a separate post providing female options for the best running shoes for bunions, coming soon.)

It’s worth noting that’s the actual width of a D fitting is not consistent across brands, so the “standard” isn’t actually standardised.

The next width up in running shoes is referred to as a “2E” fitting. This will also be referred to as a “wide” fit.

The only width above that, referred to as an extra wide, is a “4E” width. Not many brands offer a 4E width, and those that do only offer one or two models in that width.

Due to the lack of standardization of dimensions between brands, don’t automatically assume that you’re a 2E width across the board.

You might find that you require a 2E in a narrower make, like a Nike shoe. But when you switch brands to a more generous fit, like Brooks, you can actually get away with a standard D fitting.

It’s also worth noting different brands and different models have different shapes to them.

Some shoes are built on a straight last (“last” refers to the shape of shoe/foot) while others are built on a curved last.

This will mean that while some shoes have adequate width, they feel like they push too much on one side of the toes.

This is due to a mismatch in the shape of the shoe and your foot.

Finding the right stability

As bunions are an indication of long-term stability issues, it’s a fair assumption that the best running shoes for bunions should offer more support.

Support levels are usually rated as minimal, moderate and maximal.

(Beyond that there are also “motion control” shoes, however these are best only used on the recommendation of a Podiatrist or Physiotherapist.)

The consideration of which support level is best for you comes down to two things.

Firstly, consider your ability to stabilize the leg and the severity of your bunion. If your leg stability is lacking and/or your bunion make stability difficult, go for a more supportive shoe.

The second consideration is pace. The faster you run, the less support you will need.

So you may end up with two different pairs of shoes – one for your 5k parkrun or tempo run and one for your 20k long runs.

Recommendations

Here’s a list of the best running shoes for bunions that we have tried, been recommended or received great feedback.

They are all wide fit (2E) or extra wide fit (4E) and offer different levels of support.

Start by trying out shoes from the brands you’ve used before and have found comfortable.

Best running shoes for bunions in a wide (2E) fit

Minimal support level, 2E width (wide)

New Balance 990
Brooks Ravenna

Moderate support level, 2E width (wide)

Asics Gel GT-2000
Mizuno Wave Inspire
Hoka One One Arahi
Saucony Guide
New Balance Fresh Foam 860

Maximal support level, 2E width (wide)

Brooks Adrenaline GTS
Hoka One One Gaviota
Asics Gel Kayano
Saucony Hurricane

Best running shoes for bunions in an extra wide (4E) fit

Minimal support level, 4E width (extra wide)

New Balance 990

Moderate support level, 4E width (extra wide)

Asics Gel GT-2000
New Balance Fresh Foam 860

Maximal support level, 4E width (extra wide)

Asics Gel Kayano
Brooks Adrenaline GTS

10 ways to keep running through an injury

by Pete Colagiuri - Sports Physiotherapist

For any runner, running through an injury is a dilemma that you’ll face sooner or later.

This is because a running program is designed to stress your body to get it to respond and improve.

So during that stress and recovery cycle, it’s possible that the stress may lead to inflammation and injury.

Once you experience the early signs of a niggle, it’s important that you don’t stop training completely.

That often amplifies the causes of the injury and makes things worse in the long run. You can read more about that here.

So you’re then faced with the choice: either back off your training or continue running through an injury.

Running through an injury

Depending on the injury and the injured area, there’s often away you can modify your training and continue running through an injury without losing training volume.

Here’s a list of common running injuries and ways that you can modify your training.

Click on the injury to get more detailed information about it.

Running injuries and modifications to training

Achilles tendinopathy

Achilles tendinopathy is a painful reaction inside the Achilles tendon.

This injury actually prefer more regular running rather than having extended breaks.

It’s just one example of when running through an injury is your best approach.

Modification

Switch to running 5 to 7 days a week and reduce your distance per session to maintain your weekly running distance (eg. 3 x 12km = 36km/week, which becomes 6 x 6km to maintain 36km/week.)

ITB syndrome

ITB syndrome is caused by a poorly controlled inwards rotation of the leg, usually due to muscle fatigue.

If you can improve leg rotation control, the injury typically settles down and resolves.

Modification

Reduce the effect of fatigue by adding a 2 minute walk break after every 6 to 8 minutes of running.

Improve leg biomechanics by running slightly faster than your current pace – read more about how this works here.

You can also instantly improve your leg control with the addition of Low Dye taping or soft orthotics.

Plantarfasciitis

Plantar fasciitis can be the results of ankle or calf tightness, poor stability and/or poor choice of footwear.

It can be difficult to monitor as it often warms up after the first few kilometres of running.

Modification

You can instantly improve plantarfasciitis by supporting it with Low Dye taping.

Move your sessions away from grass and onto hard surfaces (helps improve foot stability.)

Move your sessions to flat ground and away from hills.

Shin splints

Shin splints covers a broad range of injuries and then each got slightly different modifications.

Whether you should continue running through an injury really depends on the underlying diagnosis of your shin splints.

Three most common types of shin splints are tibial bone stress injury, tibial periostitis and chronic exertional compartment syndrome.

Modifications

Tibia bone stress injury: reduce your training session distance so that your symptoms resolve sooner after each run and avoid downhill running.

Tibial periostitis: start each run with a 5 minute brisk walk to allow the pain to ease and avoid hard downhill running.

Chronic exertional compartment syndrome: add in a 2 minute walk break every 6 to 8 minutes to allow the compartment pressure to ease during the run.

Proximal hamstring tendinopathy

Proximal hamstring tendinopathy is often a chronic injury so any improvements are gradual.

You can keep running through an injury but you need to maintain some consistency in your approach to detect results.

Modification

Reduce fast and uphill running for a few weeks.

Add in some gentle running drills at the start of each session to improve tendon bounce.

Calf muscle overload

Calf muscle overload often feels like deep pain and tightness through the calf area.

These symptoms can often get mixed up with the symptoms of tibial bone issues so it’s worth confirming the diagnosis if it’s not improving.

Modification

Move your hill training onto stairs and ensure you place your whole foot on the step (not just your toes).

Use cross training every third day instead of running to give your calf muscles time to recover.

Deep hip rotator overload

Literally a pain in the bum, this injury is often a sign that your training beyond your current capacity.

You can read about the injury in detail here.

Modification

Where possible, some of your training onto technical trails as this provides more variety for the deep hip rotator muscles.

Switch your tempo or continuous running into an interval format with faster running and regular breaks.

Patellar tendinopathy

Patellar tendinopathy is a gradual onset injury and shouldn’t be mixed up with Osgood Schlatters disease or patellofemoral pain syndrome.

Modification

Avoid downhill or stair running – if there is a hill on your regular run, turn around and run down backwards to take all pressure away from the tendon.

For trail running, stay away from technical trail whenever possible.

FAI

Hip impingement can be tricky because it can trigger in slightly different positions for everyone.

Modification

Avoid any significant hills as these are associated with increased hip movement.

Reduce your fast paced running to a level that feels comfortable and doesn’t trigger the injury.

Lower back pain

Running with an injury like lower back pain really depends on avoiding specific cause of your issue.

Commonly this relates to hip movement or muscle overload.

Modification

Reduce the pace and duration of your run to reduce the chance of a cumulative muscle overload.

Avoid hilly runs as they often force hip movement and cause pressure on the back.