Stuart Butler MSc MCSP - Medical Lead England Athletics - @physiobutler

As a physiotherapist with over 15 years’ experience in track and field I've seen my fair share of feet, some good, some bad and many doing amazing things. With a sports science degree, I've got a keen interest in biomechanics so athletics is a natural draw and I've been hooked for years.

Foot and ankle biomechanics, lower limb biomechanics and kinematic data are all part of a full 'runners’ assessment. Their complex interactions create a clinical maze of information and have taught me to be very specific and only try and change one variable at a time. We know very few biomechanical traits can be linked to injury and that load is king. We talk a lot about acute to chronic workloads and how ‘spikes’ in load can predispose athletes to injury. We are trying to integrate this thinking into our coach education program. Spikes in load are probably the most common reason I see patients and a big point of patient education that I incorporate into the treatment plan.

A few observations from multiple championships and many miles travelled: sprinters tend to have flexible flat feet: good for creating force through the floor and endurance runners tend to have stiffer higher arched feet to allow them to be efficient across the surface. Both need to monitor load. Athlete's rarely need anything in spikes (just too small and they tend to be more fore/midfoot striking) but we can and have, used orthotics to aid load management.

For me, an orthotic has a shape, a shell material and top cover and they all act to assist in load management. They may be an off the shelf device or a custom device depending on an individual's need and the time frame we have to work in. Elite endurance runners may run 100-120 miles per week and we may want to keep the volume by assisting them with a device. Sometimes a device may allow an athlete to cope with more volume, whilst there is a thorough rehab / prehab plan in place. Those decisions are made as part of an athlete-centred plan often involving Coaches, Sport and Exercise Medicine Doctors, Physiotherapists, Podiatrists, Strength and Conditioning Coaches, etc and clear communication is vital. These are often individually specific with an eye of evidence-based medicine, but sometimes with backs to the wall at championships we may have to be inventive and there’s always a supply of felt, foam, EVA and glue! And again, we monitor load because load is the single biggest factor in injury prediction.

I’m still proud to be involved in a general clinic in Guildford, Surrey with my youngest patient being 6 and the oldest 96! The pathologies don’t tend to differ, I see lots of bony and tendon pathology and love to use some real-time ultrasound imaging to aid diagnosis and often provide reassurance to the patient, but maybe sport provides extra time / career pressures. Appropriate load management and solid pre/rehab plan really are key, even if you're trying to run a couch to 5km or international marathon and I truly believe that if the training load is gradually and progressively developed with good running mechanics (for the individual) then there’s no reason we can’t run. I believe that strength and conditioning often are underrated in endurance runners, and should form part of the total program. There’s good evidence that S&C will improve 5 and 10km running times and we know recent research has even suggested that running causes less knee OA, so the aim is to keep people moving and achieving their 150 mins (including 75 mins of intense exercise) of physical activity a week!

Stuart Butler @ Butler Physiotherapy, Chilworth Surrey.

Clinical inquiries on 01483571783 /