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Ct Band Syndrome
By Dr. Jeffrey A. Oster, Medical Director Of, Thu Dec 8th

The CT Band is the structure that enables the calf to deliverforce or load to the foot. The CT (calf- to-toes) Band is madeup of the calf, Achilles tendon and plantar fascia. The CT Bandcan 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 backof the heel and continues to the toes. The CT Band is the mostpowerful lever arm system in the human body and is prone tooveruse problems.

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

Achilles tendonitis

Plantar fasciitis

Sever's Disease

Plantar fibromatosis


So what causes CT band Syndrome? Intrinsic load is consideredthe primary contributing factor in all cases of CT BandSyndrome. Extrinsic load is considered a secondary contributingfactor in many cases of CT Band Syndrome (please see thebiomechanics tab below for a detailed description of intrinsicand extrinsic load).

Extrinsic load may vary significantly on a day to day basis. Forinstance, employment may require a patient to stand for a longduration of time but on days off work, or when on vacation, thepatient may sit for longer periods of time. For runners, thefrequency of steps and duration of time on their feet will varybased upon their running schedule. As you can see, extrinsicload varies dramatically on a day to day basis and is considereda secondary loading issue.

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

Once you understand the concept of intrinsic load you'll startto see real life examples of how and why the symptoms of CT BandSyndrome can change on a daily basis. Anyone with plantarfasciitis will tell you "My symptoms don't seem to have apattern and change from day to day. Yesterday I got out of bedand it really killed me. Today it feels pretty good'. The sameholds true for Achilles tendonitis and each of the otherconditions known collectively as CT Band Syndrome.

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

Activities that will increase intrinsic load and contribute toCT Band Syndrome

Going barefoot Wearing just your socks around the house Lowheeled shoes such as boat shoes and slippers Activities thatwill decrease intrinsic load and help heal CT Band Syndrome

Heel lift (not a heel cushion) Shoes with an elevated heel suchas 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 alwayscareful to discuss orthotics in a subtle way. In many casesorthotics are the result of lots of work and lots of money. Canthey work in cases of CT Band Syndrome? Yes. Are they alwaysnecessary? No. The best starting point is a simple firm heellift. We use a 40 durometer (firm) 3/8" heel lift in all casesof CT Band Syndrome. If you're wearing a shoe with a heel thenthe 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 calfstretches would increase intrinsic load. What we look for withcalf stretches is the net effect. Stretch several times each dayand at the end of the day the CT Band will be weaker.

Treating CT Band Syndrome is a bit of a balancing act. The firststep is to try to decrease intrinsic load with heel lift andcalf stretching. For more than half of the patients we see withCT Band Syndrome, simple calf stretches and heel lifts are allthat is needed. Another 25% of patients may require ananti-inflammatory and more time. CT Band Syndrome that lastsmore than 6 months is considered chronic and may require surgeryspecific for the condition. For plantar fasciitis we recommendand endoscopic release of the fascia. For Achilles tendonitis,an endoscopic gastrocnemius recession often helps. 90% or moreof cases of CT Band Syndrome respond to conservative care. Besure to give conservative care a reasonable chance

prior toconsidering a surgical solution.


CT Band - Stand for calf-to-toes.

Gastroc-soleal complex - The combination of the gastrocnemiusand soleus muscles.

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

Tarsitis - inflammatory pain of the tarsal bones.


The CT Band consists of the gastroc-soleal complex, Achillestendon and plantar fascia. The muscles of the gastroc-solealcomplex (gastrocnemius and soleus) descend the leg to merge andform the Achilles tendon. The Achilles tendon inserts into theback of the heel. The origin of the plantar fascia is on thebottom of the heel. The plantar fascia extends distally to mergewith the structures on the ball of the foot and toes.

There has been debate regarding whether or not the fibers of theAchilles tendon continue around the heel to the bottom of theheel to become the plantar fascia. Some authors believe there isa continuation of the fibers of the Achilles tendon while othersfeel that the Achilles tendon and plantar fascia are twodistinctly different structures. For the purpose of ourdiscussion regarding The CT Band, we will consider the CT Band afunctional structure and not a true anatomical structure.

The gastroc-soleal (GSC) represent the single most powerfulmuscle group in the human body. The load delivered to the footfrom contraction of the GSC is transferred to the foot throughthe Achilles tendon into the plantar fascia. Subsequently, theAchilles tendon and plantar fascia cannot be considered isolatedstructures, but instead need to be thought of as a functionalextension of the GSC. Think of the Achilles tendon and plantarfascia as a portion of a much larger structure called the CTBand (calf to toes). The CT Band includes the gastrocnemius andsoleus muscles, the Achilles tendon and the plantar fascia. To alesser degree, the plantaris muscle and tendon may also beconsidered a portion of the CT Band.


The primary function of the foot is to accept load andtranslate that load into a biomechanical action such as walkingor running. This translation of load is described by structuralengineers as a class one lever arm. A lever arm is a device thatis used to transfer load more efficiently. A common example of aclass one lever arm is when a large rock is moved by use of asmaller rock and a long stick. The small rock is placed close tothe large rock and the stick is wedged under the big rock andover the small rock. The small rock becomes the fulcrum. Theshort 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 becomesthe effort arm. The foot becomes the resistance arm and theankle is the fulcrum. The calf is what delivers the load throughthe CT Band to the lever arm.

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

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

Intrinsic Load Primary - gastrocnemius and soleus musclesSecondary - Secondary plantarflexor* muscles including theperoneal, plantaris, posterior tibial and long flexors tendons *Secondary plantarflexors are muscles who's secondary action isplantarflexion. 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 thefoot from a source other than intrinsic load. Extrinsic loadincludes such factors as body weight, duration of standing andfrequency of steps.

Body weight Duration of time on the feet Frequency of stepsIntrinsic and extrinsic load will vary in each patient on a dayby day basis. Therefore, when we discuss the biomechanical loadproperties applied to the foot, the definition of load is thevariable sum of both intrinsic and extrinsic load.


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

About the author:Jeffrey A. Oster, DPM, C.Ped is a board certified foot and anklesurgeon. Dr. Oster is also board certified in pedorthics. Dr.Oster is medical director of and isin active practice in Granville, Ohio.


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