The CT
band is the
structure that enables the delivery
of
force from the calf to the foot. The CT band (calf- to-toes) can be described as a
group of 8 muscles and tendons that have their origin in the posterior lower
leg. These muscles and tendons descend the leg to the posterior
ankle. Several of the tendons insert into the heel while others continue on
to the bottom of the foot to the toes. The CT band functions as a lever and is the
most powerful lever in the human body.
Levers are machines that use force to move load. Levers consist of an effort
arm and a resistance arm. In The CT band, the calf is the effort arm and
the foot is the resistance arm. The effort arm delivers force through The
CT band using the ankle as the fulcrum or hinge. An good analogy is to describe
The CT Band as another common lever, a nut cracker. One
arm of the nut cracker applies force (effort arm) while the other arm provides
resistance (resistance arm).
Researchers in the field of biomechanics believe that walking is no more
complex than a controlled forward fall. That forward fall is initiated by the
body's center of mass moving forward. The CT band creates a dynamic interface
with the supporting surface (the ground), controlling the forward rat of the
tibia (lower leg) over the foot. An actual fall is avoided as we put our
opposite foot forward. And to continue walking, the cycle begins again with contraction of
the CT band in the opposite leg.
CT Band Syndrome
CT band syndrome (CTBS) refers to a number of overuse problems found within the course of the
CT band. A partial list of those problems would include;
So what actually causes CT band syndrome? The force generated by the CT band
limits the forward excursion of the tibia over the foot over and over throughout
a typical day. The sum of force and load carried by the CT band can be so great that it
results in injury of one or more of the structures of the CT band. CT band syndrome occurs as the result of repetitive loading
that cannot be repaired within a reasonable period of time (usually 24 hours).
Once you understand how force and load are transferred by the CT band, you’ll
start to see how variation in activities and shoes can influence the onset of CT
band syndrome.
Activities that will increase
force and contribute to CT band syndrome
- Going barefoot.
- Wearing just your socks around the house.
- Low heeled shoes such as boat shoes, slippers, moccasins or flip-flops.
Activities that will decrease
force and help heal CT band syndrome
- Heel lift (not a heel cushion).
- Shoes with an elevated heel such as cowboy boots or a
wedged sole (1 1/2).
- Calf stretches.
CT Band Syndrome - Translational and
Rotational Conditions and Injuries
CT band syndrome is a group of related conditions and injuries that have a
translational or rotational basis for their onset, continued presence or
recurrence.
Type 1 CT Band Syndrome - Translational Conditions and Injuries -
A sustained increase in the duration of loading, frequency of loading or
amount of load applied to the CT band in the sagital plane may result in
translational CT band syndrome conditions and injuries. Common CT band
syndrome translational injuries include plantar fasciitis and Achilles
tendonitis.
Type 2 CT Band Syndrome - Rotational Conditions and Injuries –
Conditions and injuries that promote deviation of CT band dynamics from
the sagital plane will result rotational CT band syndrome (CTBS 2a). Rotational
CT band injuries may be due to congenital, acquired or inherited
deformities of the foot. Congenital deformities include metatarsus
adductus, calcaneal varus, pes planus or talipes equino varus. Acquired
deformities include posterior tibial tendon dysfunction or a complete
rupture of the peroneus longus tendon. Inherited deformities include
neuromuscular diseases such as Charcot-Marie Toothe Disease.
Effective translation within the CT band is accomplished by an
agonist/antagonist relationship of the secondary plantarflexors muscles
and tendons. Disruption of this agonist/antagonist relationship results
in rotation. For instance, the posterior tibial muscle and tendon
along with the peroneal muscles and tendons contribute to stability of
the foot during each of the phases of stance. Dysfunction or injury to
one of these muscles or tendons will result in eccentric loading of The
CT band and subsequent Type 2b CT band syndrome.
CT Band Syndrome as a repetitive use injury
Walking is achieved by repetitive CT band dynamics. If conditions or
injuries are present that contribute to translational or rotational CT band
syndrome, repeated CT band dynamics may initiate or perpetuate CT band
syndrome. Therefore, CT band syndrome can be considered a repetitive use injury
that has a translational, rotational or combined translational/rotational basis.
Treatment of CT Band Syndrome
First and foremost in
treating CT band syndrome is the act of weakening the force delivered by the
calf to the foot.
Force can be reduced by using a
heel lift and
by doing calf
stretches. For more than half of the patients we see with CT band syndrome,
simple calf stretches and heel lifts are all that is needed to relieve the
symptoms of CT band syndrome. Another 25% of
patients may require an oral anti-inflammatory (NSAID) or injectable steroid in addition to lifts and
stretches. CT band syndrome that
lasts more than 4-6 months is considered chronic and may require surgery specific
for the condition. For instance, resistant cases of plantar fasciitis may
require an endoscopic release of
the fascia. For Achilles tendonitis, an endoscopic gastrocnemius recession often
helps. But it's important to remember that 90% of cases of CT band syndrome respond to conservative care. Be
sure to give conservative care a reasonable chance prior to considering a
surgical solution.
