Understanding Supination Resistance

This is a concept based on how much force is needed to supinate the foot. The concept is that different feet need different forces to supinate them. This means that different structures will be overloaded if that force is high or low. It also means that different amounts of force are needed from foot orthotics if that force is high or low if the foot orthotic is going to change the position or alignment of the foot or if it changes it too much.

By way of example, if the force to supinate the foot is low, then the peroneal muscles have to work harder, predisposing the tendons to peroneal tendinopathy. If the force supinate the foot is high, then the posterior tibial muscle has to work harder, which might increase the risk for posterior tibial tendonitis. If that force is high, then a more rigid inverted foot orthotic that supplies more force is going to be needed to overcome that force.

This video from PodChatLive on the supination resistance test discussed with all the key researchers on the topic:

There have also been plenty of discussions on supination resistance on Podiatry Arena. The most comprehensive article online is this one: The concept of ‘Supination Resistance’ and this encyclopedic entry on supination resistance.

Peroneal Tendonitis in Runners

Peroneal Tendonitis is not that common in runners, but it probably is the most common cause of pain on the outside of the ankle area in runners.

Peroneal Tendonitis

This usually starts of as just an ache either just above or below that lateral malleolus (ankle bone) where the tendon runs past. It will get worse with activity and is helped with rest. The most common cause of the problem is simple overuse – too much load is applied to the peroneal tendons when they have not been given enough time to adapt or get used to the loads. It is also more likely to occur in those with ankle that roll outwards easily (lower supination resistance) as this makes the peroneal muscles work harder resulting in the inflammation of the tendon that is peroneal tendonitis.

The simplest solution to peroneal tendonitis is simply reducing load and putting a lateral wedge in the shoe to make the foot roll inwards so that the peroneal muscles do not have to work so hard. Loading programs and strengthening of the peroneal muscles are also helpful as that can help the tendon adapt to the loads of higher volumes of running.

Arch Supporting Flip Flops

Foot orthotics are a very effective modality used by podiatrists to treat a wide range of foot problems. All the clinical experiences and research evidence is that they are pretty effective. However, one problem with them is that they need to be worn in shoes. That is obviously a lifestyle choice, but sometimes the choices and the environment do not necessarily accommodate the use of the right footwear which foot orthotics can be worn in.

One question that you see asked often is that are those flip flops that have an arch support built into them, can they be used instead of foot orthotics. There are a number of brands on the market of flip flops that have varying amounts of arch support built into them.

Arch Supporting Flip Flops

Are they as good as foot orthotics?

Probably not. The support that is built into them is comparable to what you would get from a prefabricated foot orthotics or one of the common over-the-counter type of foot supports. That is fine if you have an average arch shape. However, that is no good if you don’t. Foot orthotics are usually designed to be specific to your foot type.

Should you use them?

There is no harm in using them and they certainly can be used as an adjunct to foot orthotics when you are not wearing shoes. As if they can be used as an alternative, you would need to discuss that with your podiatrist.

I do keep hearing about the Archies online, but I have not seen them as they are from Australia. Apparently a lot of podiatry clinics in Australia sell them.

Dealing with Sever’s Disease

Sever’s disease is a common problem in children who are still growing. The medical terms for Sever’s disease is calcaneal apophysitis. It is an overuse injury of the growth plate at the back of the heel bone. This is a self limiting problem, in that the child will always grow out of it when growth in the bone stops, usually around the mid-teenage years. The classic symptoms are pain at the back and sides of the heel bone, especially after exercise. The definitive cause is not totally clear, but it is an overuse injury as it is more common in children.

One of the best resources or discussions on this condition is this video on Calcaneal apophysitis (Sever’s disease) from PodChatLive:

The treatment of Sever’s disease is basically a matter of managing the loads and the lifestyle, perhaps with heel pads and just waiting for the natural history of the condition to takes its course. This can at times be difficult as children tend not to be too compliant with advice to cut back on activity levels when their parents are not around.

Plantar Plate Dysfunction

Plantar plate dysfuncion is a common strain or tear of the strong ligament that is under the metatarsophalangeal joint of the foot and forms part of the joint capsule. The classic location of the symptoms are typically just over and just distal to the joint on palpation (see the typical area in the diagram below):

Plantar Plate Dysfunction

A rather odd symptom that some with plantar plate dysfunction can describe is that it can feel like a sock is bunched up under the area, but when they check the sock is not like that at all. The cause of a plantar plate tear is not really clear, but it occurs in people with a number of risk factors and is an overuse problem.

Fixing a plantar plate tear is not that difficult, but it can take a long time and patient is needed. The best approach is to use strapping to hold the toe plantarflexed. The tape needs to be used for quite a few months to rest the area to allow it to heal. A rocker sole shoe and also help restrict movement at the joint further rest the injured area. Surgery to repair the tear is indicated if this conservative approach does not help.

Chilblains in Miami!

This is not something that happens in Miami. Chilblains are a common vasospastic problem of the toes in the colder climates, so not our problem. The cause is the microcirculation of the toes not responding to changes in temperature properly and so cause an inflammatory reaction. That causes a painful and itchy red spot on the skin that eventually becomes a darker color if the chilblain becomes chronic.


However, one thing that is starting to show given the issues surrounding the coronavirus and COVID-19 is the issue that has been given some mileage in the media and called ‘COVID toes‘. This is the occurrence of chilblains type lesions on the toes in those infected with the virus which is showing up in the not so cold climates. This means that a suspicious red patch on the toes need to be investigated properly, especially if it looks like a chilblain in Miami!

See this video from PodChatLive for more on the chilblains that are occurring in those with COVID-19:

All of the latest research on chilblains is covered on Podiatry Arena and these does seem to be quite a lack of it, but given its involvement in COVID toes, hopefyllu more research is done on them.