competitive runner

Distance Runner with plantar fasciitis, Achilles tendonitis, history of stress fractures, IT band syndrome, switched to Xero (0 drop) from Asics Kayano.

I. Athlete Injury & Overview

• Athlete: 46-year-old high-mileage runner.

• Injury: Plantar fasciitis, Achilles tendonitis, IT band discomfort. Past stress fractures.

• Biomechanics: Excessive pronation, tight posterior chain. Gait analysis in Xero: early heel rise, prolonged pronation with abductory twist, increased rearfoot eversion, forward trunk lean with increased knee flexion.

• Footwear: Xero (0mm drop) vs. Asics Kayano (10-11.5mm drop). Medial wear on Xero.

II. Podiatric Assessment & Treatment

• Assessment: Pain at medial calcaneal tubercle, plantar fascia, Achilles insertion, and posterior calf. Limited dorsiflexion. X-ray: decreased arch, calcaneal enthesophyte.

• Treatment: Physical therapy (dry needling), orthotics in low-drop shoes or shoe upgrade. Transition to low-drop with training.

• Timeline: 4-6 weeks for full activity, focusing on posterior chain and gait training.

III. Product Innovation & Recommendations

• Footwear: Transition to 4mm drop (New Balance Fresh Foam X More v5) for midfoot strike and intrinsic strengthening. This helps the patient meet her goal of dropping drop profile without doing it too quick.

• Orthotics: Custom orthotic with deep heel cup, horseshoe pad for enthesophyte, medial arch support, dual-density EVA, posts, and medial wedge.

• Compression: 30 mmHg compression sleeve during weight-bearing.

• New Ideas: Silicone gel heel insert for enthesophyte integrated in the 30mmHg plantar fascia sleeve with dual posterior and plantar gel. A 3 part adaptable shoe insert series for gradual minimalist transition (9-12 months) for athletes interested in moving to minimalist. It features a modular design with removable mm drop reduction with a dual density foam like EVA or poron. The insert series components would progress in small, manageable increments (e.g., 12mm -> 10mm -> 8mm -> 6mm -> 4mm -> 0mm).

IV. Performance & Prevention

• Return: Education on shoe gear, stretching, and minimalist transition. The Born to Run “on trend” Barefoot or 0 drop is a possibility in these patients but really requires work and realistic expectations.

• Prevention: Gait training (with/without orthotics), interossei muscle training, posterior chain work, higher drop shoe with orthotic. Good 6mm drop would be On CloudMonster Hyper or Adidas Adios Pro. A nice 6-8mm drop transition could be the Nike Vaporfly.

• Performance: Return to activity within 6 weeks with daily protocol and barefoot training.

• Long-Term: Aim for minimal orthotic use. Maintain 4mm-8mm drop for running until ready (and might not be fully ready due to history of stress fractures, set realistic expectation for goals). Xero for walking/errands. Continue weight-bearing, calcium/vitamin D. Consider injection, shock wave therapy if slow improvement or symptoms persists.