The CT Band is the structure that enables the calf to deliver force or load to the foot. The CT (calf- to-toes) Band is made up of the calf, Achilles tendon and plantar fascia. The CT Band can be described as a band that begins at the back of the knee, descends the leg to the back of the heel, wraps around the back of the heel and continues to the toes. The CT Band is the most powerful lever arm system in the human body and is prone to overuse problems.

CT Band Syndrome refers to any overuse problem found along the course of the CT Band. Problems considered part of CT Band Syndrome include;

Achilles tendonitis

Plantar fasciitis

Sever's Disease

Plantar fibromatosis

Tarsitis

So what causes CT band Syndrome? Intrinsic load is considered the primary contributing factor in all cases of CT Band Syndrome. Extrinsic load is considered a secondary contributing factor in many cases of CT Band Syndrome (please see the biomechanics tab below for a detailed description of intrinsic and extrinsic load).

Extrinsic load may vary significantly on a day to day basis. For instance, employment may require a patient to stand for a long duration of time but on days off work, or when on vacation, the patient may sit for longer periods of time. For runners, the frequency of steps and duration of time on their feet will vary based upon their running schedule. As you can see, extrinsic load varies dramatically on a day to day basis and is considered a secondary loading issue.

So for each of the conditions considered to be a part of CT Band Syndrome, what's the common problem? The answer is excessive intrinsic load. What's the solution to the problem? Weaken the intrinsic load applied to the foot.

Once you understand the concept of intrinsic load you'll start to see real life examples of how and why the symptoms of CT Band Syndrome can change on a daily basis. Anyone with plantar fasciitis will tell you "My symptoms don't seem to have a pattern and change from day to day. Yesterday I got out of bed and it really killed me. Today it feels pretty good'. The same holds true for Achilles tendonitis and each of the other conditions known collectively as CT Band Syndrome.

Let's use another example. Say you're suffering from plantar fasciitis. When you get home from work or get back from a run you kick off your shoes. You then spend the rest of the day running around the house in socks or in your bare feet. You're guaranteed that you'll feel your plantar fasciitis the next day getting out of bed. Why? Going barefoot just contributed to increased intrinsic load and to CT Band Syndrome.

Activities that will increase intrinsic load and contribute to CT Band Syndrome

Going barefoot Wearing just your socks around the house Low heeled shoes such as boat shoes and slippers Activities that will decrease intrinsic load 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

Treatment of CT Band Syndrome

What's the roll of orthotics in CT Band Syndrome? I'm always careful to discuss orthotics in a subtle way. In many cases orthotics are the result of lots of work and lots of money. Can they work in cases of CT Band Syndrome? Yes. Are they always necessary? No. The best starting point is a simple firm heel lift. We use a 40 durometer (firm) 3/8" heel lift in all cases of CT Band Syndrome. If you're wearing a shoe with a heel then the heel lift becomes redundant and is unnecessary.

Calf stretches are a must in all cases of CT Band Syndrome. What's a calf stretch do? At first you may think that calf stretches would increase intrinsic load. What we look for with calf stretches is the net effect. Stretch several times each day and at the end of the day the CT Band will be weaker.

Treating CT Band Syndrome is a bit of a balancing act. The first step is to try to decrease intrinsic load with heel lift and calf stretching. For more than half of the patients we see with CT Band Syndrome, simple calf stretches and heel lifts are all that is needed. Another 25% of patients may require an anti-inflammatory and more time. CT Band Syndrome that lasts more than 6 months is considered chronic and may require surgery specific for the condition. For plantar fasciitis we recommend and endoscopic release of the fascia. For Achilles tendonitis, an endoscopic gastrocnemius recession often helps. 90% or more 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.

Nomenclature:

CT Band - Stand for calf-to-toes.

Gastroc-soleal complex - The combination of the gastrocnemius and soleus muscles.

Plantar fibromatosis - firm fibrous nodules found in the body of the plantar fascia.

Tarsitis - inflammatory pain of the tarsal bones.

Anatomy:

The CT Band consists of the gastroc-soleal complex, Achilles tendon and plantar fascia. The muscles of the gastroc-soleal complex (gastrocnemius and soleus) descend the leg to merge and form the Achilles tendon. The Achilles tendon inserts into the back of the heel. The origin of the plantar fascia is on the bottom of the heel. The plantar fascia extends distally to merge with the structures on the ball of the foot and toes.

There has been debate regarding whether or not the fibers of the Achilles tendon continue around the heel to the bottom of the heel to become the plantar fascia. Some authors believe there is a continuation of the fibers of the Achilles tendon while others feel that the Achilles tendon and plantar fascia are two distinctly different structures. For the purpose of our discussion regarding The CT Band, we will consider the CT Band a functional structure and not a true anatomical structure.

The gastroc-soleal (GSC) represent the single most powerful muscle group in the human body. The load delivered to the foot from contraction of the GSC is transferred to the foot through the Achilles tendon into the plantar fascia. Subsequently, the Achilles tendon and plantar fascia cannot be considered isolated structures, but instead need to be thought of as a functional extension of the GSC. Think of the Achilles tendon and plantar fascia as a portion of a much larger structure called the CT Band (calf to toes). The CT Band includes the gastrocnemius and soleus muscles, the Achilles tendon and the plantar fascia. To a lesser degree, the plantaris muscle and tendon may also be considered a portion of the CT Band.

Biomechanics:

The primary function of the foot is to accept load and translate that load into a biomechanical action such as walking or running. This translation of load is described by structural engineers as a class one lever arm. A lever arm is a device that is used to transfer load more efficiently. A common example of a class one lever arm is when a large rock is moved by use of a smaller rock and a long stick. The small rock is placed close to the large rock and the stick is wedged under the big rock and over the small rock. The small rock becomes the fulcrum. The short arm of the stick (between the small rock and the big rock) becomes the resistance arm. The longer portion of the stick (between the small rock and the person) becomes the effort arm.

Compare this example to the leg, ankle and foot. The leg becomes the effort arm. The foot becomes the resistance arm and the ankle is the fulcrum. The calf is what delivers the load through the CT Band to the lever arm.

The two types of load that are applied to the foot can be defined as intrinsic and extrinsic.

Intrinsic load refers to the biomechanical load that is applied to the foot by The CT Band.

Intrinsic Load Primary - gastrocnemius and soleus muscles Secondary - Secondary plantarflexor* muscles including the peroneal, plantaris, posterior tibial and long flexors tendons * Secondary plantarflexors are muscles who's secondary action is plantarflexion. Their primary action may be arch support, stability of the foot or contolling the motion of the toes.

Extrinsic load may be defined as any load that is applied to the foot from a source other than intrinsic load. Extrinsic load includes such factors as body weight, duration of standing and frequency of steps.

Body weight Duration of time on the feet Frequency of steps Intrinsic and extrinsic load will vary in each patient on a day by day basis. Therefore, when we discuss the biomechanical load properties applied to the foot, the definition of load is the variable sum of both intrinsic and extrinsic load.

Symptoms:

The symptoms of CT Band Syndrome will vary according to each of the individual conditions. For more information on symptoms, please see each of the individual conditions that make up CT Band Syndrome.