I am 59 years old and used to run about 20 miles per week. After I had
a semihemilaminectomy at L4-L5, I found my left gastrocnemus without
motor innervation and loss of sensory innervation in the lateral half
of my left foot, leaving me with difficulty discerning whether I was
landing flat, pronating or supernating.
I have recently started walking daily, but find that I have pain
inferior to my patella which I believe to be patella tendonitis with power
walks. I love to run as it keeps me trim and feeling good, but I'm not sure
how to procede safely. Any suggestions would be appreciated.
Ray, your gastrocs are important actors in the deceleration of your calcaneus
through your achilles tendon. Lack of power in the gastrocs also manifests as a
weak or absent ability to push off. The role of the Gastrocs at the knee is most
likely responsible for your knee pain. Your Gastrocs should help to extend the
knee in a closed chain, but their innability to do so results in your Quadraceps
having to do so more directly, leading to more compression of the
patella/femoral cartilage, and chondromalacia patella. It is possible that a
well made pair of orthotics will minimize the compression - but a video gait
analysis would be required to maximize the correction. I also suggest that you
overstrengthen your hamstrings in a functional fashion in order to substitute
for your gastrocs.
Your sense of uncertainty about the position of your foot as you hit the ground
is a function of your sensory loss. This might also add to the knee pain as
there will no doubt be times when you have to decelerate the lower quadrant at
the knee with greater force than you otherwise would.
There are several "tricks" we have used to give you sensory feedback. One idea,
that we often use with sprained ankles that might have application here, is to
use a little superglue! the tactile irritation of the superglue on the skin
often gives you excellent sensory feedback. we like to put the glue over the
anterior talo fibular ligament on the outside of the ankle/foot. Try it, and see
if it hel