CT Band Syndrome

Summary

The CT band is the group of structures that enable 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 dynamic lever and is the most powerful lever in the human body. CT band Syndrome is a group of related overuse conditions specific to the CT band.

Symptoms

• Calf pain
• Ankle pain
• Achilles tendon pain
• Posterior and plantar heel pain

Symptoms of CT band syndrome vary based upon the location of the problem within the CT band.

Description

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. A good analogy is to describe The CT Band as another common lever: a nutcracker. One arm of the nutcracker 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 rate 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 (CTBS) refers to a number of overuse problems found within the course of the CT band. A partial list of those problems include:

• Achilles tendonitis
• Plantar fasciitis
• Sever's Disease
• Plantar fibromatosis
• Tarsitis
• Midfoot arthritis

So what actually causes CT band syndrome? The force generated by the CT band limits the forward excursion of the tibia over the foot during the gait cycle. The gait cycle repeats itself 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.)

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 (CTBS1.) 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 in rotational CT band syndrome (CTBS 2.) 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.

Lever arms work most effectively in a single body plane. The CT band functions primarily in the sagital plane. This motion is linear. Linear motion in a single plane is called translation. Deviation from translation results in rotation. Another way to describe deviation from translation is to use Newton’s first law of motion. Newton stated that if a line of force passes through the center of mass, there will be no rotation on that body. The CT band moves the body’s center of mass forward, maximizing translation and minimizing rotation. Limited rotation does occur in the CT band and can help to make the CT band a more dynamic structure. Excessive rotation contributes to CT band syndrome (CTBS.)

Rotation does occur within the CT band but is typically compensated for by reciprocal or compensatory motion within the lower extremity. One example of CT band rotation is rotation that occurs in the transverse plane. Transverse plane motion occurs between the leg and supporting surface, where the leg moves from an internally rotated position at the early midstance phase of gait to an externally rotated position at the toe-off phase of gait. This transverse plane rotation is accomplished proximally by external rotation of the pelvis. Distal compensation is accomplished by motion at the subtalar joint and midtarsal joint. Although the transverse plane relationship between the leg and the floor changes, the CT band continues to deliver sagital plane load throughout the midstance phase of gait. This relationship can be described as translation with compensated rotation.

The ability of a lever arm to function within a single plane results in a more effective lever, but a rigid lever is a lever that is unable to absorb strain or adapt to variations in applied load and supporting surfaces. CT band biomechanics requires a degree of rotation to adapt to a constantly changing environment. Rotation is the quality of the CT band that enables the foot and leg to (1) absorb stress as a flexible structure (2) deliver force as a rigid structure and (3) adapt to uneven surfaces.

Causes and contributing factors

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.

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

Differential diagnosis

There is no differential diagnosis for CT band syndrome.

Treatment

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 performing calf stretches. Most CT band syndrome cases will respond in part or completely to heel lifts and stretching. Additional treatment may include use of anti-inflammatory medications, physical therapy or surgery.

When to contact your doctor

If the symptoms of CT band syndrome do not respond to a week or more of conservative care, consult your podiatrist or orthopedist specialist.

References

1. Oster, J.  The CT Band, CT Band Biomechanics and CT Band Syndrome.  The Foot and Ankle Online Journal; 2 (5): 2 May 2009

Author(s) and date

This article was written by Myfootshop.com medical advisor Jeffrey A. Oster, DPM.  

Competing Interests - None

Cite this article as: Oster, Jeffrey.  CT Band Syndrome.  https://www.myfootshop.com/article/ct-band-syndrome

Most recent article update: December 10, 2020.
 

  CT Band Syndrome by Myfootshop.com is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.