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  pieter@pieterduvenage.com   082 312 6235

Interactive Injury Assessment

Select a pain point at left to learn more about
common running injuries, how to treat them
and how to prevent them.

Greater Trochanteric Bursitis (Hip)

What do you do if you have it:
Your injury might be shoe related and
or biomechanical. The ITB Band rubs over the greater
trochanter creating shearing forces and is being overworked.

Shoe Related:
Most shoes these days delivers a part of its cushioning
sensation by means of a trampolining effect on the outside
lateral part of the heel which will cause a lateral collapse at
heel strike and force the foot into over supination.

Biomechanical Related::
By preventing excess supination of the feet, the orthotics
will reduce over supination, therefore helping to alleviate
the problem. Custom Insoles will effectively replace the
natural footprint and provide a stabilizing angle for the
calcaneus.

ASK HELP WITH THIS CONDITION

Sciatica

What do you do if you have it:
Your injury might be shoe related and or biomechanical.
There are increased twisting forces at the piriformis muscle,
which lies deep in the gluteal region and directly over top
of the sciatic nerve, compresses and puts pressure on the
nerve creating shearing forces and is being overworked.

Shoe Related:
Most shoes these days delivers a part of its cushioning
sensation by means of a trampolining effect on the outside
lateral part of the heel which will cause a lateral collapse
(excessive supination) at heel strike and force the foot into
over supination.

Biomechanical Related:
By preventing excess supination of the feet, the orthotics will
reduce over supination, therefore helping to alleviate the
problem. Custom Insoles will effectively replace the natural
footprint and provide a stabilizing angle for the calcaneus.

ASK HELP WITH THIS CONDITION

Pes Anserine Bursitis

What do you do if you have it:
The three tendons can become inflamed due to excessive
friction and is being overworked..

Shoe Related:
Most shoes these days delivers a part of its cushioning

sensation by means of a trampolining effect on the outside
lateral part of the heel which will cause a lateral collapse at
heel strike and force the foot into over supination and then
over pronation.

Biomechanical Related:
By preventing excess supination of the feet, the orthotics
will reduce over supination, therefore helping to alleviate
the problem. Custom Insoles will effectively replace the natural
footprint and provide a stabilizing angle for the calcaneus.
Excessive foot pronation can cause the lower leg to rotate too
far inward, which may increase twisting forces at the knee.

ASK HELP WITH THIS CONDITION

Patellar Tendinitis

What do you do if you have it:
The patellar tendon is being overloaded due to excessive
friction and is being overworked.

Shoe Related:
Most shoes these days delivers a part of its cushioning
sensation by means of a trampolining effect on the outside
lateral part of the heel which will cause a lateral collapse at
heel strike and force the foot into over supination and then
over pronation.

Biomechanical Related:
By preventing excess supination of the feet, the orthotics will
reduce over supination, therefore helping to alleviate the problem.
Custom Insoles will effectively replace the natural footprint and
provide a stabilizing angle for the calcaneus. Excessive foot
pronation can cause the lower leg to rotate too far inward, which
may increase twisting forces at the knee.

ASK HELP WITH THIS CONDITION

Anterior Compartment Syndrome

What it is:
Muscles in the lower leg are divided into compartments
by sheaths of fascia, which are relatively inflexible.
When muscles within a compartment increase in size,
s commonly due to increased blood flow, a corresponding
increase in pressure occurs within the compartment as the
fascia surrounding the muscles does not stretch.
The anterior (front) compartment of the lower leg is the
most common site accounting for 70% of cases.

How do I know if I have it (symptoms):
Gradual pain, cramping and tightness of the muscles
located in the front of the leg during or after exercise,
with an increase in symptom intensities even after exercise.
The area will feel tender and hot upon palpation
with occasional altered sensations in the foot, such as
numbness or tingling, and possible muscle weakness
leading to a ‘drop foot.’

What do you do if you have it:
If the condition is mild, strengthening the muscle in the
anterior compartment, as well as the other compartments
is helpful. If left undiagnosed or if the above conservative
methods were unsuccessful, a fasciotomy (the fascia
surrounding the muscles are cut) is the most effective
method to treat this condition.

ASK HELP WITH THIS CONDITION

Peroneal Tendinitis

What it is:
Peroneal tendinitis involves the irritation of
the two tendons on the outside of your ankle,
peroneus longus and brevis. These muscles are
responsible for balance and stabilization,
supporting the arch of the foot, and generating
forward propulsion along with the tibialis
posterior and calf muscles.

How do I know if I have it (symptoms):
This condition presents itself as localized pain
with swelling on the lateral (outside) ankle behind
the lateral malleolus (ankle bone) and crepitus
(a grinding sensation).

What do you do if you have it:
Strengthening the peroneal muscles through
directed exercises and balancing exercises
have been shown to aid in recovery.

ASK HELP WITH THIS CONDITION

Plantar Fasciitis

What it is:
The plantar fascia is a piece of thick tissue
spanning from your heel to your toes. Inflammation
to the tissue begins when it experiences increased
stress from either being stretched or twisted too much.

How do I know if I have it (symptoms):
Pain is usually felt near your heel and is worse in the
morning after it has had a chance to shorten overnight.
Walking and running usually help to warm up the tissue
up so symptoms don’t usually occur when you’re active.

What do you do if you have it:
The ankle stabilizing muscles, like tibialis posterior, serve
to dynamically support your arch and take the strain off
of the plantar fascia. Thus, calf raises are a necessary step
for treatment. As well, towel crunches with your toes will
strengthen the smaller arch-stabilizing muscles. A recent
study from our lab also shows that simple over-the-counter
orthotics can reduce plantar fascia stress by 35%. Finally,
many research studies have shown that atypical foot
pronation mechanics are rarely a factor to consider for
treatment and the vast majority of runners exhibit very
normal pronation mechanics.

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Morton’s Neuroma

What do you do if you have it:
Your injury might be shoe related and or biomechanical.
Excessive pressure in the ball of the foot between the third
and fourth metatarsal. Customized orthotics realign the
metatarsal heads by dorsiflexing the 2nd, 3rd & 4th
metatarsals to their neutral position, using a built-in
metatarsal raise.

By controlling excess pronation orthotics
also prevent plantar-flexion and shearing of the metatarsal
shafts. Balancing the weight distribution over the 5 metatarsal
bones helps remove excess weight and friction which commonly
causes the callous and burning sensation.

ASK HELP WITH THIS CONDITION

Patellofemoral Pain Syndrome (PFPS)

What it is:
Half of all running injuries are to the knee,
and the most common is PFPS or Runner’s
Knee. With PFPS, the patella (knee cap)
does not sit properly within the groove of
the femur (thigh bone) and repeated stress
causes pain.

How do I know if I have it (symptoms):
PFPS is characterized by aching pain under
the knee cap that is made worse by climbing
stairs, squatting, jumping, running and /or
sitting for prolonged periods of time. When
running, the pain usually begins immediately
after you stop running and worsens over the
next 1-12 hours.

What do you do if you have it:
Quad muscle strengthening has traditionally
been done to help stabilize the knee cap
within the femoral groove. While most PFPS
patients have successful short-term outcomes
following this type of rehabilitation, in follow-up
studies ranging from 5 to 25 years after
rehabilitation, 25-91% of PFPS patients report a
return of symptoms. Recent research has clearly
pointed to strengthening a key muscle in your
hip, the gluteus medius, as a critical step to better
control your femur and optimize your
rehabilitation.

ASK HELP WITH THIS CONDITION

Iliotibial Band Syndrome (ITBS)

What it is:
The second most common injury is ITBS
characterized by pain on the outside of your knee.
There is a small fluid-filled sac (a bursa) that becomes
irritated from the IT band rubbing against it.

How do I know if I have it (symptoms):
Generally, ITBS pain worsens as you continue to run
and feels like small knives are stabbing your knee.
A study conducted in our lab, and another by a
Kentucky researcher, both showed that increased
twisting forces, primarily because of reduced hip
muscle strength, are the main cause of ITBS.

What do you do if you have it:
Muscle fatigue is the key reason ITBS pain worsens
as you run. Thus, three important muscles need to
be strengthened: gluteus medius, gluteus maximus,
and tensor fascia latae. These muscles attach to the
IT band and reduce forces experienced by the tissue.
Interestingly, less than 15% of people with ITBS have
tight IT bands so stretching is not critical.

Foam rolling is helpful since it serves to break-up
adhesions, which form under the IT band as a result
of muscle weakness. Finally, unnecessarily running in
motion control shoes to try and treat ITBS has actually
been shown to increase symptoms and the chance of
occurrence.

ASK HELP WITH THIS CONDITION

Medial Tibial Stress Syndrome (Shin Splints)

What it is:
The pain associated with shin splints is, unfortunately,
the cause of an ankle stabilizing muscle, tibialis posterior,
ripping away from its attachment to the back and inside
of the tibia (shin bone). Over time, and unless properly
treated, the pain worsens and small fractures form in the tibia.

How do I know if I have it (symptoms):
Shin splints first begin as diffuse pain along the inside border
of the tibia. Unless you do something about it, the pain begins
to localize to the lower 1/3rd of the tibia (a stress reaction) that
will eventually progress to exquisite and localized pain from a
stress fracture.

What do you do if you have it:
Either the tibialis posterior is weak, or it’s being overworked
because the soleus (the deep calf muscle) is not strong enough.
Regardless, calf-raises can strengthen both muscles.

ASK HELP WITH THIS CONDITION

Tibialis Posterior Tendinitis

What it is:
Tibialis posterior is located behind the tibia
(shin bone) with the tendon running behind
the medial malleolus (inside ankle bone) and
into the arch of the foot. This muscle is
responsible for controlling foot pronation,
supporting the arch of the foot, and generating
forward propulsion along with the peroneals
and calf muscles.

How do I know if I have it (symptoms):
The pain is located on the inside of the ankle or
arch of the foot and gradually worsens with
repetitive stress.

What do you do if you have it:
Since tibialis posterior shares a role in controlling
foot pronation along with soleus (one of the calf
muscles), strengthening the tibialis posterior muscle
and soleus are critical for treatment. The short-term
use of orthoses may be effective by helping to
supporting the arch and relieving some stress placed
on the tendon.

ASK HELP WITH THIS CONDITION

Metatarsalgia

What it is:
Metatarsalgia is characterized by pain and swelling on
the ball of the foot, having a greater prevalence in older
individuals. This injury can be caused from repetitive
high-pressure loading under the metatarsal heads,
changing biomechanics while running to a forefoot strike
pattern, fat pad atrophy, or wearing improperly fitting
shoes (i.e. high heels).

How do I know if I have it (symptoms):
This injury commonly presents itself in 1 or more
metatarsal heads and the pain is most severe during
the propulsion phase of running or jumping.

What do you do if you have it:
Stretching of the Achilles tendon has been shown to
decrease forefoot loading as has improving the strength
of intrinsic foot muscles. Metatarsal pads, orthotics, shock
absorbing insoles, and properly fitting shoes have also
been shown to reduce the amount of pressure dispersed
through the metatarsal heads.

ASK HELP WITH THIS CONDITION

Achilles Tendinitis

What it is:
A common overuse injury, tendinitis occurs from
repetitive overloading of the calf muscles,
gastrocnemius and soleus, which make up the Achilles
tendon. The tendon becomes swollen and painful and
tender to the touch.

How do I know if I have it (symptoms):
The Achilles tendon itself may be painful to touch and the pain
presents in one of two areas:
(1) near the junction of the tendon and the calf muscles or
(2) in the middle of the Achilles tendon.

What do you do if you have it:
Strengthening the calf muscles through calf raises is critical for
injury resolution. Stretching the calf muscles will also help
re-orientate scar tissue that has built up inside the tendon.

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What Our Clients say about Us

My experience here was all about Brilliant technology, Product knowledge and Passion!
Pieter helped to get me more comfortable in my training shoes to the point where I need brakes now! The cutting edge 3D GAIT Analysis technology available at his practice combined with his shoe knowledge and prevention of injury mission is unmatched in South Africa. Thank you Pieter.
Jay J BotesFormer SA Decathlon Champion & Sports BroadcasterGroot Fm 90.5fm