Ankle and knee problems

[obelix74]

Hi

I am 5'9' and 190 lbs. I am very flat footed and over pronator. I started running about six months ago and dropped 10 lbs (from 200 lbs) before I was side lined with ITB, ankle pain and knee pain due to over pronation.

I read the chi running book, attended a workshop with Larry Newmann (Woodside, CA) and started practicing Chi Running. I have moderate success so far.

I had my initial injuries in June - and I have never really recovered from them. I now run with a stability shoe (Asics Fortitude). I tried off the shelf orthotics, they caused ankle pain. I was prescribed custom orthotics, I got moderately soft ones, ankle pains persist. My podiatrist now is recommending hard custom orthotics. I am waiting for them.

If I run without orthotics, I can run for a few days but then I go down with knee injury. If I run with orthotics, I go down with ankle pain rather quickly.

My podiatrist, general physician and the prosthetics person who made my orthotics - all advise me that I should give up running since I have pretty flat feet and I am at least 30 lbs overweight.

I am pretty sad and frustrated with the state of affairs .

1) What specific Chi running focuses would you recommend I should focus on?

2) What kind of shoe / orthotic support would you recommend I stick to?

My ideal hope is to eventually grow out of the stability shoe and custom orthotic to a lightweight mid foot shoe such as the NB 790. But the path from here to there is very muddy and unclear.

[Jacquie Mardell]

How much have you been running, meaning miles or minutes at a time and number of days per week? And have you checked back in with Larry for a tuneup, because he would be in the best position to evaluate your stride, having worked with you before. Without knowing the answer to any of these questions, I am wondering if you need to dial back a little bit, given your flat feet and previous injury issues. Also without seeing you, I wonder if your cadence needs to be picked up a little to minimize the time spent on your feet. Again I would want to know what Larry has to say.

[obelix74]

Jacquie

Thanks a lot for the reply.

Since May, when I was injured (my chi running workshop was in late June), I have done very little running. June - now, I have barely run about 20 times. This past two months, I would run 3-4 times across two weeks of 2 miles to 4 miles at slow pace (12 - 13 mins / mile) before my knee acts up.

With the last orthotics, two runs of < 2 miles each was enough to trigger ankle pain.

These days I spend a lot of time on an elliptical in a gym more than running.

My cadence is pretty slow as well. The last time I ran, my cadence was 79, I started at a tardy 76, but I haven't got any chance to work on it - not much running. Larry advised me to push my cadence by 1 and run on that for a couple of weeks. I hope I can start running to work on that.

It never occurred to me that I can get a tune up with Larry (even though he mentioned it). Once I can run a few miles without pain, I will head out and meet him again.

I read your other posts about orthotics. Since I know for a fact that none of my existing orthotics work and since I am waiting for my new pair, may be I should follow your advise and start running without them.

Thanks.

[Jacquie Mardell]

Definitely get back with Larry. And really really employ the concept of gradual progress, especially as you run without supports. Do only a few minutes at a time to let your body get used to it. Focus solidly on your posture and lean, and think light quick steps. Cadence will be your friend here and every beat per minute that you increase it incrementally will help you.

[obelix74]

Thanks again Jacquie

Does it sound reasonable to start with 2 miles per run (~25 mins) for 3 times a week? Is that a good enough starting point?

Yes, I will check with Larry once I get going. Looks like he doesn't have any lessons open in the near future . Bummer.

[Catriona]

Hi Larry,

I'm assuming since you over pronate that the ankle pain in on the inside ankle?

With flat feet you should probably be running with prescription orthotics in neutral shoes. The soft orthotics probably wasn't enough to stop your arch flattening out and straining your posterior tibial tendon. Hopefully once you get used to the rigid orthotics you will find you can run without ankle pain (baring in mind it will need a little time to settle down).

At this minute i'm nursing a sore ankle and knee from over pronating and waiting for my new orthotics so I feel your pain.

[obelix74]

Catriona

Larry is my chirunning instructors name .

Here is the fun part. When I run without orthotics, I eventually get knee pain on the inside bottom and ITB, which my physical therpaist says is due to over pronation and weak quads.

If I run with my orthotics (off the shelf and soft orthotics), I get ankle pain on the OUTSIDE. This makes both my PT and Larry to think that it is caused due to over correction of my shoe + orthotics.

The shoes I use are Asics Fortitude which aren't neutral, but are stability shoes to start with. The shoe store that fitted me (Running revolutions in Campbell) started me with a stability shoe and said that since I was still pronating, I needed an orthotics to offer more support.

So I think so far my shoes + orthotics have been over correcting me. I have multiple options here, since in a way I am starting over with chi running.

- Stick to my stability shoes alone
- Stick to my stability shoes and try the rigid orthotics
- Go down to a more neutral shoe and try the rigid orthotics

My hope is to keep things simple for now and try option #1. Focus entirely on form and mid foot landing and start with very short distances few times a week while doing elliptical or other cardio at the gym.

Do I make sense? Do you see anything I am missing here?

Hi Larry,

I'm assuming since you over pronate that the ankle pain in on the inside ankle?

With flat feet you should probably be running with prescription orthotics in neutral shoes. The soft orthotics probably wasn't enough to stop your arch flattening out and straining your posterior tibial tendon. Hopefully once you get used to the rigid orthotics you will find you can run without ankle pain (baring in mind it will need a little time to settle down).

At this minute i'm nursing a sore ankle and knee from over pronating and waiting for my new orthotics so I feel your pain.

[Jacquie Mardell]

Obelix, 2 miles 3 times per week, may be right, but it also may be too much, given your feet, knee, and hip issues. I would start with 10 minutes, really. It sounds like nothing, but there is a huge difference between running a tiny bit and being able to run again two days later, versus running 2 miles today and not being able to run again for two weeks! With a short run that has good form, you have something to build on. I'm not saying 10 minutes is the limit for you, I'm saying that it is a good place to start. If you feel good after 10, run one more. Then see how you feel later that day and the next morning. If good, then try again the day after that. If not good, then 10 minutes was too much, again given your specific issues. See what I mean?

[obelix74]

Jacquie

Thanks a lot. Makes sense. I will start slow.

Obelix, 2 miles 3 times per week, may be right, but it also may be too much, given your feet, knee, and hip issues. I would start with 10 minutes, really. It sounds like nothing, but there is a huge difference between running a tiny bit and being able to run again two days later, versus running 2 miles today and not being able to run again for two weeks! With a short run that has good form, you have something to build on. I'm not saying 10 minutes is the limit for you, I'm saying that it is a good place to start. If you feel good after 10, run one more. Then see how you feel later that day and the next morning. If good, then try again the day after that. If not good, then 10 minutes was too much, again given your specific issues. See what I mean?

[Catriona]

Catriona

Larry is my chirunning instructors name .

oops!

Wih regards to the orthotics I would ask your podietrists advice. Mine told me never tyo wear my orthotics with anything other than neutral shoes or there would be too much correction.

I guess your choice will depend on how much correction you need. When I was measured it turned out I was 12º out on my left foot and 10º out on my right. A normal foot would be expected to be no more than 2-4º out of "perfect" alignment. I doubt stability shoes would be able to correct than amount of deviation.

The fact the store person said you were still pronating in the stability shoes tells me you will probably need to get neutral trainers with correctly fitted orthotics.

Either way I think getting an expert opinion is advisable. Off the shelf orthotics only have around a 2º correction and you may need a more custom orthotic to start you off.

[obelix74]

Thanks.

I am ashamed to admit - I don't know what my correction values are. I have asked my orthotic provider. I will know tomorrow.

Yeah, the more I read I think what you say is right. I will get back to you tomorrow once I know the numbers.

Catriona

Larry is my chirunning instructors name .

oops!

Wih regards to the orthotics I would ask your podietrists advice. Mine told me never tyo wear my orthotics with anything other than neutral shoes or there would be too much correction.

I guess your choice will depend on how much correction you need. When I was measured it turned out I was 12º out on my left foot and 10º out on my right. A normal foot would be expected to be no more than 2-4º out of "perfect" alignment. I doubt stability shoes would be able to correct than amount of deviation.

The fact the store person said you were still pronating in the stability shoes tells me you will probably need to get neutral trainers with correctly fitted orthotics.

Either way I think getting an expert opinion is advisable. Off the shelf orthotics only have around a 2º correction and you may need a more custom orthotic to start you off.

[obelix74]

Catriona

Turns out I had 4º extrinsic rear foot varus correction. I guess I need to go back and ask my podiatrist (whose next appointment is a month away) regarding what kind of shoes I have to use. But I know for fact my existing shoes don't work.

A normal foot would be expected to be no more than 2-4º out of "perfect" alignment. I doubt stability shoes would be able to correct than amount of deviation.

Either way I think getting an expert opinion is advisable. Off the shelf orthotics only have around a 2º correction and you may need a more custom orthotic to start you off.

[Catriona]

I think my last post was a little misleading. I should have said satbility shoes would not be able to correct MY amount of deviation. I don't know how much correction stability shoes provide if any.

The 4º extrinsic rear foot varus correction you mentioned, is that the correction your insoles are giving you or is that the amont of correction you foot needs? Just asking becuase I have mid range insoles that have stick-on bases to correct 4º (by using two bases). They are Express Orthotics and cost me around £40 ($64).

Not as cheap as off-the-shelf insoles but nothing like as expensive as custom insoles.

What ever you decide to get I would get them fitted for all the shoes you intend to wear them in since different shoes house the insoles differently. I have the problem where my cheap insoles fit ok in my running shoes but my walking shoes are far to wide so they dont give my as much arch support. Thats why i'm getting a more expenive orthotic made for my walking shoes.

[obelix74]

Catriona

That is my problem with Stability and Motion Control shoes. They do not tell how much they correct - it is a black box. I know for a fact that my Motion control shoes actually give a much bigger arch which is big enough that when I slip in any orthotic inside it, it starts to give me ankle pain on the outside of the leg.

The 4º extrinsic rear foot varus correction is what my foot needs. This was what was measured after casting my leg.

Thanks - for my walking shoes, I have been using Spenco Polysorb orthotics ($45) which seem to work just fine. But the same orthotics inside my motion control running shoe give me a lot of ankle pain really quickly.

I will make sure they fit.

I think my last post was a little misleading. I should have said satbility shoes would not be able to correct MY amount of deviation. I don't know how much correction stability shoes provide if any.

The 4º extrinsic rear foot varus correction you mentioned, is that the correction your insoles are giving you or is that the amont of correction you foot needs? Just asking becuase I have mid range insoles that have stick-on bases to correct 4º (by using two bases). They are Express Orthotics and cost me around £40 ($64).

Not as cheap as off-the-shelf insoles but nothing like as expensive as custom insoles.

What ever you decide to get I would get them fitted for all the shoes you intend to wear them in since different shoes house the insoles differently. I have the problem where my cheap insoles fit ok in my running shoes but my walking shoes are far to wide so they dont give my as much arch support. Thats why i'm getting a more expenive orthotic made for my walking shoes.

[Catriona]

let me know how you get on. I'm still waiting (im)patiently for my new orthotics to be made. Was told it would take a week but that was 2 weeks ago.

[obelix74]

let me know how you get on. I'm still waiting (im)patiently for my new orthotics to be made. Was told it would take a week but that was 2 weeks ago.

will do. I started running without my insoles on my motion control shoe. fingers crossed.

[melvanl]

Something I have noticed as far as helping my running form was to practice ChiWalking more frequently. When I was nursing a sprained ankle last year I continued to ChiWalk, and when I got back to running I found my form had improved again. Sometimes moving a bit slower allows you time to focus on everything without overwhelming yourself.

I used to overpronate badly, and if you see me standing you would think I still do, but, if you look at my running shoes (which are very neutral, as well as my NB 790's), you will see that the wear is even in the midfoot region. I believe that ChiWalking allowed me to work on the proper posture and get my feet working they way they are meant to.

Just an idea.
Mel

[Jacquie Mardell]

Good comment.

[obelix74]

Mel

Thanks. I never thought about trying ChiWalking before. I will consider ChiWalking - I don't even have the book, unfortunately . I will get it.

[melvanl]

In a nutshell ChiWalking is basically ChiRunning only walking. The biggest difference is that you keep your stride the same length (quite short), and change your cadence to speed up. You still set up your posture the same way. Until you can get the book this will get you started on the road to recovery.

I miss the walks I used to incorporate into my weeks because it is so easy to feel the motions you are thinking about when walking. Also the slower pace allows you to adapt your body when you notice things don't quite feel right.

Good Luck!
Mel

[obelix74]

Mel

Thanks again for the tip.

In a nutshell ChiWalking is basically ChiRunning only walking. The biggest difference is that you keep your stride the same length (quite short), and change your cadence to speed up. You still set up your posture the same way. Until you can get the book this will get you started on the road to recovery.

I miss the walks I used to incorporate into my weeks because it is so easy to feel the motions you are thinking about when walking. Also the slower pace allows you to adapt your body when you notice things don't quite feel right.

Good Luck!
Mel