Shin Splints

Shin splints is a general term used to refer to a painful condition in the shins. It is often caused by running or jumping, and may be very slow to heal. A formal medical term for the condition is medial tibial syndrome.

Shin splints is the general name given to pain at the front of the lower leg. Shin splints is not a diagnosis in itself but a description of symptoms of which there could be a number of causes. The most common cause is inflammation of the periostium of the tibia (sheath surrounding the bone). Traction forces occur from the muscles of the lower leg on the periostium causing shin pain and inflammation.

Symptoms of shin splints:

• Tenderness over the inside of the shin.

• Lower leg pain which goes after a period of rest but comes back when running starts again.

• Sometimes some swelling.

• Lumps and bumps may be felt when feeling the inside of the shin bone.

• Pain when the toes or foot are bent downwards.

• A redness over the inside of the shin.

Shin Splints Treatment

Treatment for shin splints is a simple as reducing pain and inflammation, identifying training and biomechancial problems which may have helped cause the injury initially, restoring muscles to their original condition and gradually returning to training.

What can the athlete do about shin splints?

• Rest to allow the injury to heal.

• Apply ice or cold therapy in the early stages, particularly when it is very painful. Cold therapy reduces pain and inflammation.

• Stretch the muscles of the lower leg. In particular the tibialis posterior is associated with shin splints.

• Wear shock absorbing insoles in shoes. This helps reduce the shock on the lower leg.

• Maintain fitness with other non weight bearing exercises such as swimming, cycling or running in water.

• Apply heat and use a heat retainer or shin and calf support after the initial acute stage and particularly before training. This can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues.

• Visit a sports injury clinic for treatment and rehabilitation.

What can a sports injury clinic or doctor do?

• Prescribe anti-inflammatory medication e.g. ibuprofen. (Always consult a doctor before taking medication).

• Tape the ankle for support. – A taping worn all day will allow the shin to rest properly by taking the pressure off the muscle attachments.

• Perform gait analysis to determine if you overpronate or oversupinate

• Use sports massage techniques on the posterior deep muscle compartment but avoid the inflamed periostium.

• Operate

• Anti inflammatory drugs along with rest and ice can help reduce inflammation, particularly in the early stages. However if the underlying causes such as tight muscles are not treated through stretching and sports massage techniques then the likelihood of the injury returning is higher.

Which products can help with treatment of shin splints?

Some products which can help with treatment and prevention of shin splints are outlined below. Please consult your therapist before using any products as they may not be compatible with your particular therapists approach to treatment.

Shock absorbing insoles… Shock absorbing insoles can help reduce the shock and impact transmitted through the foot to the lower leg, particularly when running on hard surfaces for long periods of time.

Orthotic insoles… Orthotic insoles are firm insoles designed to correct biomechanical dysfunction such as over pronation. They will usually have strong arch support. Off the shelf orthotic insoles are available and suitable for many, although for the perfect fit a Podiatrist will make them specifically for your feet.

Plantar Fasciitis

Plantar fasciitis is a painful inflammatory condition of the foot caused by excessive wear to the plantar fascia that supports the arches of the foot or by biomechanical faults that cause abnormal pronation. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition.

Plantar fasciitis was formerly called “a dog’s heel” in the United Kingdom. It is sometimes known as “flip-flop disease” among US podiatrists. The condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Watch for:

• Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
• Heel pain after long periods of standing or after getting up from a seated position
• Heel pain after, but not usually during, exercise
• Mild swelling in your heel

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

• Physical activity overload. Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.
• Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
• Diabetes. Although doctors don’t know why, plantar fasciitis occurs more often in people with diabetes.
• Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia.
• Improper shoes. Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon which is attached to your heel can contract and shorten, causing strain on the tissue around your heel.

What is Metatarsalgia?

What is Metatarsalgia

Your ego used to be the only thing that got bruised during pickup basketball games. But lately, the jump’s gone out of your jump shot. You can still leap, but landing is pure torture. What’s more, running and even walking cause the same burning pain on the bottoms of your feet. If this sounds familiar, you may have metatarsalgia  a condition marked by pain and inflammation in the ball of your foot.

Metatarsalgia frequently affects runners and other athletes who participate in high-impact sports. That’s because excessive amounts of running or jumping put extra stress on the metatarsals — the long bones located in the front part of your feet just below your toes. People with certain foot shapes that create more stress on the metatarsal bones also may have these problems.

Although generally not serious, metatarsalgia can sideline you. Fortunately, conservative treatments such as ice and rest can often relieve symptoms. And proper footwear, along with shock-absorbing insoles or arch supports, may be all you need to prevent or minimize future problems.

Symptoms

The main symptom of metatarsalgia is pain in the ball of your foot the part of the sole just behind your toes. The pain may be sharp, aching or burning. You may feel it in the area around the second, third and fourth toes or only near your big toe.

Other symptoms of metatarsalgia may include:

• Pain that gets worse when you stand, walk or run and improves when you rest
• Sharp or shooting pain in your toes
• Numbness or tingling in your toes
• Pain that worsens when you flex your feet
• A feeling in your feet as if you’re walking on pebbles or have a bruise from a stone
• Increased pain when you’re walking barefoot, especially on a hard surface

Sometimes these symptoms develop suddenly especially if you’ve recently increased your usual amount of running, jumping or other high-impact exercise but problems are more likely to develop over a period of months.

Causes

In each foot, five metatarsal bones run from your arch to your toe joints. The first metatarsal is shorter and thicker than the other four bones, which are usually similar in size. During the push-off phase when you walk, jump or run, your body weight is transferred to your toes and metatarsals. The first and second metatarsal bones take the brunt of this force, which can be as much as 275 percent of your body weight.

Most metatarsal problems develop when the impact load or the mechanics of your foot affect the way your weight is distributed. This can put excess pressure on the metatarsals, leading to inflammation and pain, especially in the metatarsal heads the rounded ends of the bones that connect with your toe bones.

Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:

• Intense training or activity.
  Runners have the highest incidence of metatarsalgia, primarily because the front of the foot absorbs more force when running than during any other activity as much as 110 tons of force per mile. But anyone who participates in a high-impact sport is at risk. Training intensely or for long periods puts even more stress on the metatarsals, often leading to chronic irritation and inflammation.
• Certain foot shapes.
  A high arch can put extra pressure on the metatarsals. So can having a second toe that’s longer than the big toe, which causes more weight than normal to be shifted to the second metatarsal head.
• Hammertoe.
  This foot problem can develop when high heels or too-small shoes prevent your toes from lying flat. As a result, one of your toes usually the second curls downward because of a bend in the middle toe joint. This contraction depresses the metatarsal heads.
• Bunion.
  This is a swollen, painful bump at the base of your big toe. Sometimes the tendency to develop bunions is inherited, but the problem can also result from wearing high heels or too-small shoes. Bunions are much more common in women than in men. A bunion can weaken your big toe, putting extra stress on the ball of your foot. Sometimes surgery to correct a bunion can also lead to metatarsalgia.
• Excess weight.
  Because most of your body weight transfers to your forefoot when you move, even a few extra pounds mean more pressure on your metatarsals. Sometimes losing weight reduces or eliminates symptoms of metatarsalgia.
• Poorly fitting shoes.
  High heels, which cause more weight to be transferred to the front of the foot, are one of the most common causes of metatarsalgia in women. Shoes with a narrow toe box or athletic shoes that lack support and padding also can contribute to metatarsal problems.
• Stress fractures.
  Small breaks in the metatarsals or toe bones can be painful and change the way you put weight on your foot.
• Morton’s neuroma.
  This noncancerous growth of fibrous tissue most often occurs between the third and fourth metatarsal heads. It causes symptoms that are similar to metatarsalgia and can also contribute to metatarsal stress. Morton’s neuroma frequently results from wearing high heels or too-tight shoes that put pressure on your toes. It can also develop after high-impact activities such as jogging and aerobics.
• Aging.
  As you grow older, the fat pads on the balls of your feet become thinner. This makes the metatarsal bones more susceptible to injury.

Risk factors

Almost anyone can develop metatarsalgia, but you’re at higher risk if you:

• Participate in high-impactsports. Metatarsalgia is most likely if you’re a runner or participate in other sports that involve running or jumping, such as soccer, tennis, baseball, football or basketball. Swimming and cycling, which don’t put pressure on your forefoot, aren’t likely to cause metatarsalgia.
• Wear high heels or shoes that don’t fit properly. High heels transfer extra weight onto the front of your foot, and shoes that are too tight can compress your toes. Wearing athletic shoes that aren’t well padded or that aren’t appropriate for a particular sport for example, playing basketball in tennis shoes also can put you at risk of metatarsalgia.
• Are overweight. Extra pounds put more pressure on your metatarsals.
• Have other foot problems. Certain foot shapes such as high arches, a long second toe or unusually long metatarsals can contribute to metatarsalgia. So can conditions such as hammertoe, Morton’s neuroma, arthritis and even gout. These can cause pain and inflammation that change the way you walk and the distribution of weight in your feet.

Mallet Toes

What are hammer, claw, and mallet toes?

Hammer, claw, and mallet toes are toes that changed into an irregular shape, they may look odd and/or may hurt. The muscles that control your toes get out of balance and cause the toe to bend into an odd position at one or more joints. These toe problems almost always happen in the four smaller toes, not the big toe.

If you notice that your toe looks odd or hurts, talk to your doctor. You may be able to fix your toe with home treatment. If you do not treat your toe right away, you are more likely to need surgery.

These toe problems develop over years and are common in adults. Women have more of these problems than men because of the types of shoes they may wear, such as high heels.

What causes hammer, claw, and mallet toes?

Tight shoes are the most common cause of these toe problems. Wearing tight shoes can cause the toe muscles to get out of balance. Two muscles work together to straighten and bend the toes. If a shoe forces a toe to stay in a bent position for too long, the muscles tighten and the tendons shorten (contract). This makes it harder to straighten the toe. Over time, the toe muscles cannot straighten the toe, even if you are not wearing
shoes.

Less common causes include:

• Problems in foot structure at birth. This may run in families.

• Joint diseases, such as rheumatoid arthritis.

• Brain, spinal cord, or nerve injury (especially in the case of claw toe). Examples include stroke, cerebral palsy, and degenerative disc disease.

• Not using your toe. Having to stay in bed for a long period of time may cause muscles to shorten (contractures). This may lead to toe problems.

• Poor blood flow to your feet (peripheral arterial disease).

• Having little or no “feeling” in your feet (peripheral neuropathy). This is common in people with diabetes.

• Injury, such as breaking a toe.

What are the symptoms?

Pain and a toe that looks odd are symptoms of hammer, claw, and mallet toes. The toe may rub against your footwear, and you may have trouble finding shoes that fit.

• A hammer toe is a toe that bends down toward the floor at the middle toe joint. It usually happens in the second toe. This causes the middle toe joint to rise up. Hammer toes often occur with bunions.

• Claw toe often happens in the four smaller toes at the same time. The toes bend up at the joints where the toes and the foot meet. They bend down at both the middle joints and at the joints nearest the tip of the toes. This causes the toes to curl down toward the floor.

• A mallet toe often happens in the second toe, but it may happen in the other toes as well. The toe bends down at the joint closest to the tip of the toe.

In more severe cases, these toe problems may affect your balance and make it hard to walk. You may get calluses or corns where a bent toe presses against your shoe.

How are hammer, claw, and mallet toes diagnosed?

Your doctor will diagnose your toe problem by looking at your toes and asking you questions about your symptoms. People rarely need tests. Your doctor may suggest an X-ray to look at the bone structure, especially if you are thinking about having surgery.

How are they treated?

You can treat hammer, claw, and mallet toes at home by wearing footwear with lots of room for your toes, using pads and supports in the shoe, and doing toe exercises. Doing these things will give the toe room to straighten, cushion the toe and hold it straight, and make the toe muscles stronger and more flexible. You can use over-the-counter medicine to treat pain.

If your pain is too great or you cannot easily do daily activities, then surgery is possible. But there is not much research on surgeries for these toe problems. Talk to your doctor about the types of surgeries and how much they may help you.

Surgery may not help how your foot looks, and your toe problem may also come back after surgery. This is more likely if you continue to wear the types of shoes that cause toe problems.

What is an Ingrown Toenail

What is an ingrown toenail?

An ingrown toenail is a painful condition of the toe. It occurs when a sharp corner of the toenail digs into the skin at the end of or side of the toe. Pain and inflammation at the spot where the nail curls into the skin occurs first. Later, the inflamed area can begin to grow extra tissue or drain yellowish fluid.

• If left untreated, an ingrown toenail can progress to an infection or even an abscess that requires surgical treatment.
• Ingrown toenails are common in adults but uncommon in children and infants. They are more common in men than in women. Teenagers and young adults are most at risk.
• Any toenail can become ingrown, but the condition is usually found in the big toe.

Ingrown Toenail Causes

• Tight-fitting shoes or high heels cause the toes to be compressed together and pressures the nail to grow abnormally.
• Improper trimming of toenails can cause the corners of the nail to dig into the skin. Nails should be trimmed straight across, not rounded.
• Disorders such as fungal infections of the nail can cause a thickened or widened toenail to develop.
• Either an acute injury near the nail or anything that causes the nail to be damaged repetitively (such as playing soccer) can also cause an ingrown nail.
• If a member of your family has an ingrown toenail, then you are more likely to develop one, too. Some people’s nails are normally more rounded than others, which increases the chance of developing ingrown nails.

Ingrown Toenail Symptoms

Ingrown toenail is a common disorder that most often affects the outer edge of the big toe. However, the nail on any toe, or the nail on both sides of a toe, can become ingrown. The most common signs and symptoms are pain, redness, and swelling at the corner of a toenail.

• Early in the course of an ingrown toenail, the end of the toe becomes reddened and painful with mild swelling. There is no pus or drainage. It may feel warm to the touch, but you will not have a fever.
• Later, extra skin and tissue will grow around the sharp point of the nail. A yellowish drainage may begin. This is the body’s response to the trauma of a nail irritating the skin and is not necessarily an infection.
• Sometimes an infection develops. In this case, the swelling will become worse, and there may be white- or yellow-colored drainage from the area. A lighter-colored area of the skin may be surrounded by red skin. You may develop a fever, although this is unusual.

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Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome) is a common injury to the thigh, generally associated with running, cycling, hiking or weight-lifting (especially squats).

IBS is one of the leading causes of lateral knee pain in runners. The iliotibial tract is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front while walking. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

IBS symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present below the knee, where the ITB actually attaches to the tibia.

ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. It commonly occurs during pregnancy, as the connective tissues loosen and the woman gains weight — each process adding more pressure. ITBS at the hip also commonly affects the elderly. ITBS at the hip is studied less; few treatments are generally known.

Sports activities to avoid while symptomatic

• Running
• Stair climbing
• Deadlifts or squats
• Court sports, such as tennis, basketball, or similar
• Martial arts, such as karate (especially where being bare foot emphasizes any symptoms being caused by leg/foot abnormalities)
• Cycling
• Bowling

IBS can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:

Training habits:

• Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
• Inadequate warm-up or cool-down
• Increasing distance too quickly or excessive downhill running
• In cycling, having the feet “toed-in” to an excessive angle
• Running up and down stairs
• Hiking long distances

Abnormalities in leg/feet anatomy:

• High or low arches
• Over pronation of the foot
• The force at the knee when the foot strikes
• Uneven leg length
• Bowlegs or tightness about the iliotibial band.
• Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bow leggedness for runners.

Muscle imbalance:

• Weak hip abductor muscles
• Weak/non-firing multifidi muscles

While pain is acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Massage therapy may also be beneficial. Using a foam roller to loosen the iliotibial band can help prevent and treat pain although the treatment itself can be very painful to some.

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