Gait and Foot pain in a 30 year runner. A possible Forefoot varus.

Hi Gait Guys:

I could use some help. I’ve been running/cycling for 30 years. Three years ago, I had surgery on my left knee that realigned my patella (lateral release.) Until recently, I lived in custom orthotics and motion control shoes. I’ve been reading chi-running and natural running and bought a pair of shoes for which I’m transitioning a little a day. My left foot is the problem: it severly overpronates and I have a neuroma. I’ve been walking barefoot and in five-fingers for a while and my feet a definitely getting much better. The natural running style feels much better on my ankles,knees and hips, which used to hurt a lot. Also, cycling hurts only when I get off my bike, my knee is killing me for a while.

My left forefront seems to move too much even with this new style of walking/running. I’m wondering if I have forefront varus that could be helped with a wedge. My real problem is that I currently live in Las Cruces, NM, where there is no running store and no experts on this stuff. Most podiatrists do the same, generic thing for all patients. Is there a little wedge I could try without having it inserted into a custom orthotic? Is there a place to go to analyze my gait/running that would be worth my time and expense to visit? Any advice would be gratefully received.

Thanks for your time, …. AT

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Thanks for the note AT.

We are glad that the natural style running is helping. remember to go slowly and follow the rules of Skill, Endurance, Strength as you progress into less supportive shoes.

The forefoot motion you are sensing MAY indeed be a forefoot varus; we would need to see and examine your foot to know for sure. The fact that you have had a neuroma and needed a lateral release are suspect for a forefoot varus.  With that 1st metatarsal head (the medial tripod) unstable and allowing more forefoot pronation your control of internal rotation of that limb is going to be difficult and drag patellar tracking off line. If it is a rigid deformity, it may never totally be gone, though you may be able to increase the range of motion of your foot sufficiently to compensate elsewhere. We have attached a photo of a prefabricated forefoot varus post (note its thickness on the outside edge and tapering as it moves inwards to the pre-fab it is attached to. It is a wedge.). In our in-house labs we make them custom to the client to get perfect control. We make them out of thermo-rubber-infused cork so we can grind them down as clients earn better ability to anchor the metatarsal tripod with intrinsic muscle strength through our specific exercise programs. It is also used for Rothbart Foot types which has some similarities to a forefoot varus. Make sure you do not have a Rothbart variant. We did a blog post on Rothbart many years ago. Search for in the search box from our archives.

Getting a thorough evaluation is paramount. We are not aware of any gait labs in Las Cruces, but Jaqueline Perry’s Pathokinesiology lab is in Rancho Los Amigos (click here for more info). Dr Waerlop is located about 70 miles west of Denver and Dr Allen is in the Chicago suburbs. Only after an evaluation, could exercise suggestions or an orthotic or other device recommendation could be made.

Thanks for your inquiry

Ivo and Shawn