Talkback: Physio webchat with Matt Todman

I got a knee injury (though running) over 11 months ago now.  An ultra sound scan showed a muscle tear but despite resting, physio and sports massage I cant seem to get rid of this injury.  Usually the pain increases gradually after 2-3 miles so it isnt immediate.  I also feel the same pain when hill walking but not cyclying.  I would really like to start training again properly but am finding it impossible with this consistent injury.  What can I do to get rid of this injury once and forall


  • Hi Matt,

    I've had an on-going problem for the last six months, a pain alongside the outside of my left foot mainly underneath the ball of the toe. 

    My GP was pretty useless when I went to see him (didn't even ask me to take off my trainer) but he did send me for an x-ray and it came back all clear. 

    I've had a similar pain in the same place on my right foot and a physio I've seen thinks it could be down to putting too much weight through the outside of my foot when I overpronate. 

    No running and some exercises are helping the problem but after three weeks I can still feel it when I've been on my feet a long time. 

    What can I do to prevent the problem coming back in the future? Should I try to change the way I land my feet when I run?

    I'm 28, 69kgs and clocking up about 40 miles a week (before I stopped at three weeks ago) and am planning to run Vienna marathon in April. 



  • I have been diagnosed with bursitis in the 4th and 5th toes of my left foot. I've had the pain for approx six months and have only just been diagnosed correctly. I haven't run for all this time and am missing it terribly. 

    Any idea if and when I can start running again?

     Oh, and I've had no treatment as of yet, what if any treatment can I get? 

  • Hi Susan


    Like anything, given the correct environment, you will get better. If however you don’t provide the correct environment, you’ll destroy more cells than you create and you won’t get better.


    So, you’re not getting better…and I think it’s because despite all your best efforts you don’t have enough control or stability of your back, pelvis, hip and foot to allow your tissue to heal.


    This is not about getting stronger, it’s about getting good flexibility in the tissue surrounding the tear and allowing excessive load to be taken away from the healed/healing tissue – and at 11 months you should be well healed.


    Foam rolling your quads, hip flexors and adductors. Improve glut control in single knee squat and ballistic lunges. Start a progressive loading program where you slowly introduce running on the flat – little and often. If it hurts, then slow down or stop.

  • Hi Tim


    This sounds like you’ve got a supination issue rather than a pronation issue.


    Over pronation is a much bandied about term, but it’s not about how much you pronate (foot rolls in) but how much control you do or don’t have over it. Pronation is normal and necessary, but not enough control can mean that your foot becomes excessively mobile.


    Supination is the same, in reverse! Supination is rolling out. When your heel hits the ground, your foot is in a supinated (or rolled out) position. Normally the foot now rolls in (pronates) to help take out the ground reaction force. As you walk over your foot and prepare to push off your big toe, the foot re supinates and stiffens the foot for propulsion.


    This makes me think that you don’t roll in very much because your foot is too stiff, you’re stuck in a supinated position and you take your entire load on the outside of your foot.


    You’ll need to have a shoe that has lots of cushioning and is very neutral. You want to encourage movement, not limit of control it. Sorbothane insoles may also help.


    Lots of calf stretches, not necessarily to increase calf length but to improve mobility and motion of your foot and ankle joint. Rolling your foot on a can may also help with foot mobility.


  • Hi Zoe

    Odd! Fibroma, yes. Neuroma, yes. Lipoma, yes....bursa?

    I guess it doesn't matter on what, but you need to understand why to shape your rehab and treatment paln going forward....

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  • Have had a niggling pain on my left heel up through me calf since August, I took a two week rest but the niggle remained, tried strengthing the calfs with heel raises and using ice and heat treatment, which seemed to help but not cure, this however has not prevented me from running etc... more recent after coming back from a virus a pain started on the inside of my left leg.  I have had some treatment on two occassions and on both occassions my hips where not aligned.  I have started work on strengthing myhips etc... and general core work the pain seems to be subsiding but the original issue still underlying.  What advice/direction would you advise me to go down to get this niggles sorted. 
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