Shin Splints Shin splints (medial tibial stress syndrome pain) occurs along the inner edge of the shinbone (tibia) in the lower leg. It results from repeated stress and trauma to the to the connective muscle tissue surrounding the tibia on your shinbone causing the shinbone to become inflamed and painful.The most common area for shin splints is the medial area on the inside of the shin. Anterior shin splints which develop toward the outside of the leg usually result from an imbalance between the calf muscles and the muscles in the front of your leg, and often afflict beginners who either have not yet adjusted to the stresses of running or have not stretching enough. A sudden increase in intensity or frequency in running fatigues muscles too quickly to properly help absorb shock forcing the tibia to absorb most of that shock. This stress is associated with the onset of shin splints. Common Causes of Shin Splints Overpronation is a frequent cause of medial shin splints. Inadequate stretching and worn running shoes. Excessive stress placed on one leg or one hip from running on cambered roads or always running in the same direction on a track. Typically one leg is involved and it is almost always the runner’s dominant one. If you’re right handed you’re usually right footed as well and that’s the leg that’s going to hurt. Beginner runners who do not build their mileage gradually or experienced runners who abruptly change their workout regimen. suddenly switching from running on flat surfaces to hills or adding too much mileage. Signs and Symptoms of shin splints ? A dull ache to an intense pain that increases during exercise. ? Biomechanically over pronation is a common factor in shin splints and action should be taken to improve the biomechanics of the gait. ? Muscle imbalance, including weak core muscles, inflexibility and tightness of lower leg muscles can increase the possibility of shin splints. ? The impact is made worse by running uphill, downhill and on uneven terrain, or on hard surfaces. ? Improper footwear including worn out runners. ? Shin splints are also at their most painful when you forcibly try to lift your foot up at the ankle and flex your foot. Shin pain doesn’t always mean you have shin splints. It might be a sign of some other problem. It is important to differentiate between different lower leg pain injuries, including shin splints, stress fractures, compartment syndrome, nerve entrapment, and popliteal artery entrapment syndrome. These conditions often have many overlapping symptoms which makes a final diagnosis difficult, and correct diagnosis is needed to determine the most appropriate treatment. The pain of shin splints is also more generalized than that of a stress fracture. Press your fingertips along your shin, and if you can find a definite spot of sharp pain it’s a sign of a stress fracture. Additionally, stress fractures often feel better in the morning because the bone has rested all night while shin splints often feel worse in the morning because the soft tissue tightens overnight. Treatment of Shin Splints When shin splints strike you should stop running completely or reduce your training depending on the severity and duration of pain. ? A first step should be to ice your shin to reduce inflammation. ? If you have medial shin splints you should gently stretch your achilles and stretch your calves if you have anterior shin splints. ? If you decide to continue running use either tape or an ace bandage starting just above the ankle and continuing to just below the knee. Keep wrapping your leg until the pain goes away, which usually takes three to six weeks. This procedure binds the tendons up against the shaft of the shin to prevent stress. ? Consider cross training for a while to let your shin heal. Swim, run in the pool or ride a bike. ? When you return to running, increase your mileage slowly, no more than 10 percent weekly. ? Make sure you wear the correct running shoes for your foot type specifically, overpronators should wear motion control shoes. ? Severe overpronators may need orthotics. Have two pairs of shoes and alternate wearing them to vary the stresses on your legs. ? Avoid hills and excessively hard surfaces until shin pain goes away completely and re introduce these forms of training gradually to prevent a recurrence. ? If you frequently run on roads with an obvious camber, run out and back on the same side of the road. Likewise, when running on a track, switch directions. ? If you are prone to developing shin splints, stretch your calves and Achilles regularly as a preventive measure. If shin splints are not treated properly or if exercise is resumed too early or aggressively, shin splints can become permanent. Shin splints can be diagnosed by a physician using gentle pressure to determine whether there is tenderness over a four to six inch section on the lower inside shin area.
Sesamoiditis is a common ailment of the plantar forefoot which causes pain in the ball of the foot specifically under the big toe joint. The sesamoid bones are very small bones which are located under the big toe joint within the tendons that run to the big toe. They work to increase the leverage of the tendons that control the big toe. Due to their location and function they are subjected to massive pressure and forces every time the big toe is used to push the foot forward. Activities such as running which involves repetitive excessive loading of the ball of the foot can lead to this condition. Runners with boney, higher arched feet, runners with flat feet or those who tend to run on the ball of their foot also tend to be more prone to sesamoiditis.
Symptoms of Sesamoiditis
Sesamoiditis typically presents as a mild ache increasing gradually where it can become an intense throbbing in the ball of the foot. .
Treatments for Sesamoiditis
These will vary between patients and will typically involve a period of rest from any activities likely to aggravate the problem. ? Immobilization strapping, ice and oral anti inflammatory drugs may also be utilized to settle inflammation and pain and aid in the healing process. ? Wearing a soft full length functional orthotic insole is commonly used to offload the sesamoids and deflect pressure away from the pain area. Orthotics are essential in treating an underlying causative foot condition such as flat feet, high arched feet, bunions or those with reduced plantar fatty padding.
Supinator Supination (or under pronation) is the opposite of pronation and refers to the outward roll of the foot during normal motion causing it to twist akwardly leading to ankle injuries and sprains. A natural amount of supination occurs during the push off phase of the running gait as the heel lifts off the ground and the forefoot and toes are used to propel the body forward. However if supination continues through to the toe off phase the weight isn’t transferred to the big toe resulting in all of the work being done by the outer edge of the foot and smaller toes placing extra stress of the foot. Supination is seen more often in runners with high, rigid arches that don’t flatten enough during the stride. Diagnosing Your Gait Pattern ? By looking at your shoe wear pattern you can determine if you are a supinator. This is the key to selecting the right running shoes. ? Follow this up by an assessment at a good quality running shoe store. ? A foot gait analysis or a foot pressure scan are methods used in specialized running shoe stores to get a full picture of your gait pattern and where you place stress on your foot. Supinators will see more wear on the outside edge of their running shoes. Causes of Supination ? Internal causes can include rigid joints, alignment problems in the heel or the ball of the foot or strength and flexibility imbalance in the ankle. ? When you naturally underpronate the muscles and joints in your feet are working to try to correct the imbalance leading to issues in other joints like your knees and hips. ? External causes include unstable or worn out footwear or running on uneven surfaces. Effects of Supination ? Issues from overcompensation includes stress fractures which is the most serious effect of underpronation/supination. ? A high risk of overuse injuries such as achilles tendonitis, muscle strains, ankle injuries, iliotibial band syndrome and plantar fasciitis. Treatment of Supination ? Wearing neutral, flexible and well cushioned running shoes that can absorb more of the impact of each stride, provide a better range of motion and improve running comfort. ? If you have a severe supination problem you should see a podiatrist for custom orthotics. ? If you have ongoing foot or ankle pain, numbness, tingling, loss of function, or an injury you should see a podiatrist to fully diagnose your foot.
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of connective tissue that runs across the bottom of the foot and connects the heel bone to the toes and supports the arch of the foot. During movement the pain normally decreases but returns after long periods of standing or inactivity. It is common in runners. In addition runners who are overweight and who wear running shoes with inadequate support have an increased risk of this foot condition. Heel pain is worsened by bearing weight on the heel after long periods of rest.Ignoring plantar fasciitis may result in chronic heel pain that can hinder your daily activities.
Symptoms of Plantar Fasciitis
Plantar fasciitis typically causes a stabbing pain in the bottom of the foot near the heel. The pain is usually worst with the first few steps after awakening. The pain is usually more severe after exercise, not during it. Pain is also frequently brought on by bending the foot and toes up towards the shin when doing stretching exercises
Causes of Plantar Fasciitis
Under normal circumstances, your plantar fascia acts like a shock absorbing bowstring supporting the arch in your foot. ? If tension and stress on that bowstring become too great small tears can arise in the fascia. ? Repetitive stretching can cause the fascia to become irritated or inflamed.
Though plantar fasciitis can arise without an obvious cause certain factors can increase your risk of developing it. ? It is most common between the ages of forty and sixty. ? Long distance running places a lot of stress on your heel and the attached tissue and can contribute to an earlier onset of plantar fasciitis. ? Being flat footed, having a high arch or an abnormal pattern of running can affect the way weight is distributed and put added stress on the plantar fascia. ? Excessive running, standing on hard surfaces for prolonged periods of time, high arched feet or flat feet and the presence of a leg length inequality, . ? The tendency of flat feet to excessively roll inward during running makes them more susceptible to plantar fasciitis. ? Achilles tendon tightness and inappropriate footwear.
Treatments for Plantar Fasciitis
Most cases of plantar fasciitis resolve with time and conservative methods of treatment. ? Resting, massaging, icing and take pain medications within the first few weeks of symptons developing. ? Calf strengthening exercises, and techniques to stretch the achilles tendon, and plantar fascia. ? Using a gel heel cradle to cushion and support the heel If the pain is specifically in the heel of the foot. ? Using a foot roller to roll out the foot at night can also help. If this is not sufficient, physiotherapy, orthotics, splinting, or steroid injections may be required. If the plantar fascia continues to be overused while suffering from plantar fasciitis the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot. About 90% of plantar fasciitis cases will improve within six months with conservative treatment and within a year regardless of treatment
Overpronation occurs in running when the arch of the foot rolls inwards or downwards excessively rather than the natural way of pronating from side to side. The way a person’s foot strikes the ground can have significant effects on their body. Athletes with flat feet or who overpronate may be prone to developing overuse running injuries because it disrupts the body’s natural alignment causing increased impact when the foot strikes the ground. Pronation occurs as weight is transferred from the heel to the ball of the foot as an athlete goes through their walking or running stride. There is initial contact with the outside of the heel upon initial contact with the ground. When the foot continues to roll the ball of the foot will tilt inwards more than the ideal 15 degrees. This means the foot and ankle have problems stabalizing the body and shock isnt absorbed efficiently. At end of the cycle the front of the foot is pushing off the big and second toe causing an excessive force. This motion can cause extreme stress or inflammation on the plantar fascia, potentially causing severe discomfort and leading to other foot problems.
Causes of Overpronation
? Fallen Arches & Flat Feet ? Common foot deformities and or a flexible muscle structure. ? Being Pregnant. ? Being Overweight or Obese. ? Repeatedly striking the foot on a hard surface for an extended period when running.
Symptons of Overpronation
? Walking & Running becomes awkward and causes increased strain on the feet and calves. ? Strain on the big toe and second toe and instability in the foot. ? No clear space between the foot and the ground where the arch should be while standing. ? Majority of wear on inside (big toe side) of running shoes. Overpronators will see their heel print connected with the full width of their foot when taking the wet footprint test. If a person suspects that they are overpronating they can do a test by doing one of the three following methods: ? They should first look at their feet while standing. If there is no clear space between the foot and the floor where the arch should be the person likely overpronates. ? They can check the condition of their running shoes. If the majority of the wear is on the inner part of the running shoes they are likely a person with overpronation. ? They can also check their footprint after taking a few steps with bare wet feet over brown paper. A person with normal pronation will see their heelprint connected to their toeprints with about half of their foot width showing. A person who overpronates will see their heelprint connected with the full width of their foot.
Injuries associated with Overpronation
? Shin Splints ? Bunions ? Heel Pain ? Plantar Fasciitis ? Iliotibial Band Syndrome (inflammation of a ligament on the outside of the knee) ? Chronic Lower Back Pain ? Stress Fractures in the Foot or Lower Leg ? Achilles Tendonitis
Treatments for Overpronation
? Using orthotic running insoles designed with appropriate arch support to prevent overpronation. ? Wearing stability running shoes that feature a firm heel counter and wide soles. ? Strengthening the foot muscles by toe curls, heel raises and other exercises to improve foot support, stability and shock absorption. Many people who overpronate know they have flat feet without seeing a doctor. An athlete should see a specialist for overpronation if they are experiencing chronic injury or pain, especially if they have tried to self correct the problem themselves.
Morton’s Neuroma is a painful foot condition that affects one of the nerves between the toes causing the toes to become irritated and thickened. The condition can occur in one foot or both feet as a result of wearing tight running shoes. It usually affects the nerve between the third and fourth toes but occassionaly the nerve between the second and third toes can also become affected. The condition has been linked to other foot problems, such as flat feet, high arches and bunions.
Causes of Morton’s Neuroma
The exact cause of the irritation is unknown but it may be caused by the nerve being squashed (compressed), stretched or damaged.
Symptoms of Morton’s Neuroma
Typically, there’s no outward sign of this condition. Instead you may experience some of the following symptoms ? A tingling sensation in the space between your toes which gets worse over time developing into a sharp shooting or burning pain in the ball of your foot or at the base of your toes. ? Numbness in your toes. ? The pain is often worse from wearing tight running shoes that compress the feet. ? A feeling as if you’re standing on a pebble in your shoe. ? A burning pain in the ball of your foot that may radiate into your toes. If you have persistent symptoms of Morton’s Neuroma it is unlikely to improve on its own you should seek medical advice.
Treating Morton’s Neuroma
Treatment for Morton’s neuroma will depend on how long you’ve had the condition and its severity. Simple non surgical treatments are effective for some people. ? Changing your footwear with a wider toe area may help ease the pressure on the nerve in your foot. ? A soft cushioning insole for the ball of your foot may help relieve the pressure on the affected nerve. ? Resting your foot and massaging and icing your toes may also help relieve the pain. ? Anti inflammatory painkillers such as ibuprofen can be helpful to ease the pain and inflammation. ? Losing weight may reduce the strain on your feet when running. Surgery or steroid injections for Morton’s Neuroma is usually only recommended if you have very severe pain or if the treatments above haven’t worked. In this case, your GP can refer you to a podiatric or orthopaedic surgeon to discuss whether surgery is suitable for you. Surgical procedures include ? Increasing the space around the nerve by removing some of the surrounding tissue. The procedure is usually carried out using a general anaesthetic or local anaesthetic. Most people who have surgery to treat Morton’s neuroma have positive results and their pain is relieved afterwards.
Metatarsalgia(Forefoot Pain) is a common overuse running injury. It is a condition in which the ball of the foot becomes painful and inflamed especially the area between your arch and the toes. The pain usually centers on one or more of the five bones (metatarsals) in this area under the toes.
The pain comes on over a period of several months rather than suddenly as the delicate balance between bones is disrupted.
It often occurs as a result of symptoms of other conditions. Although generally not serious, metatarsalgia can sideline you for a period of time.
Track and field runners are exposed to the highest level of traumatic forces to the forefoot,
Causes of Metatarsalgia
? An enlarged metatarsal head. ? Arthritis or any degenerative disease of the joints. ? Systemic conditions such as diabetes, which can cause nerve type pain in the foot. ? Calluses or skin lesions that cause the weight on the foot to be unevenly distributed. ? Ageing which tends to thin out or shift the fatty tissue of the foot pad. ? Tight fitting running shoes that put pressure on the bones of the feet. ? Shoes with small toe boxes that cramp your toes. ? A burning pain in the ball of your foot that doesn’t improve after changing your shoes and modifying your activities. ? Discomfort when wearing shoes and socks. ? Foot deformities and shoes that are too tight or too loose. ? Bone abnormalities to systemic diseases such as diabetes. Alteration of the posture in the long bones (metatarsals) of the foot which absorb weight during running. Weakness, lack of support and abnormally long or stress fractured bones will create dysfunction among all the bones.
Symptons of Metatarsalgia
? Sharp, aching or burning pain at the end of one or more of the metatarsal bones ? A shooting pain, numbness or tingling in your toes. The pain worsens when you stand, run, flex your feet or walk especially barefoot on a hard surface and improves when you rest. ? Callus (Build up of Skin) that forms on the bottom of your foot as a result of excessive pressure over the bone. If any of the above symptons are severe seek medical advice.
Treatments for Metatarsalgia
? Wearing proper footwear with shock absorbing insoles or arch supports can prevent or minimize future problems with metatarsalgia. ? Soaking your feet to soften calluses and then removing some of the dead skin with a pumice stone or callus file will also ease pressure. ? Using appropriate properly fitting running shoes with a wide toe box that distributes weight and pressure evenly across the foot. ? Massaging the afflicted area to relieve swelling pressure, increase local circulation and reduce your pain.
A heel spur is a calcium deposit that builds up over a period of months causing a bony protrusion on the underside of the heel bone causing heel pain. It can extend forward by as much as a half inch and is caused by strains on foot muscles and ligaments.Although heel spurs are often painless they can cause heel pain. They are frequently associated with plantar fasciitis. An inferior calcaneal spur can be found at the interior part of the heel and is usually associated with plantar fasciitis. Another type of heel spur is posterior calcaneal spur which develops on the back of the heel near the Achilles tendon. Heel spurs are especially common among athletes whose activities include large amounts of running.
Causes of Heel Spurs
? Muscle or ligament strains (or both) in your foot. ? In addition, heel spurs can appear when the membrane that covers your heel bone is worn away by shoes that don’t fit correctly, ? Excessive weight or an imbalance in the way you move. ? Overstretching the stretching of the plantar fascia and repeated tearing of the membrane that covers the heel bone are other causes.
Symptons of Heel Spurs
? Pain around the area of the heel spur. ? Finding it intolerable to put weight on the affected heel.
Treatments for Heel Spurs & Heel Pain
A heel spur is treated similarly to plantar fasciitis because both conditions are related.
The initial treatment for a heel spur is rest and control of the inflammation.
? Stretching exercises. ? Taping or strapping to rest stressed muscles and tendons.
? Physical Therapy. ? Foot orthotics or running inserts.
? Anti inflammatory medications and cortisone injections.
Rest from running to avoid aggravation of the sympton
? Applying ice packs can help to reduce the symptoms of heel pain.
? Medications such as anti inflammatory medicines can be prescribed to relieve inflammation and foot pain.
Recommended treatment for heel spur syndromes vary based on specific symptoms.
Heel pain caused by excessive pronation and torquing of the fascia may be treated with orthotic insoles which help to stabilize pronation and arch elongation.
If conservative treatments fail, surgery may be necessary.
Flat Feet & Fallen arches are a condition of the feet that can cause pain and discomfort when the arch in the bottom of your foot collapses. The pulling of the Tendons that attach at the heel and foot bones form the arch (the upward curve in the middle of the foot) When the tendons do not pull as they should the condition of fallen arches arises.and your feet may appear flat. Several tendons in your foot and lower leg work together to form the arches in your foot. When the tendons pull properly your foot forms a moderate, normal arch. When tendons do not pull together properly, there is little or no arch. This is called flat foot or fallen arch. If you do a an arch water test you might notice when you see your bare footprint that the arch is not visible in the print.
Causes of Fallen Arches
There are several factors that can contribute to the development of fallen arches. •Genetic abnormality; •Torn or stretched tendons. •Damage to the posterior tibial tendon. •Bone fractures or dislocation of bones. •Nerve damage. •Rheumatoid arthritis •Diabetes •Pregnancy •Obesity and Aging.
Symptoms of Fallen Arches
•Foot pain, particularly in the arches or heels. •Leg or back pain. •Swelling and tiredness in the feet. •Difficulty moving the feet. •Improper balance on feet which in turn causes other biomechanical injuries such as back, leg and knee pain.
Treatment Options for Fallen Arches
•Elevation of the feet and application of ice to ease discomfort and reduce swelling, Rest •Exercises to stretch the feet. •Medication such as anti inflammatories. •Orthotic insoles or customised arch supports to wear in your running shoes. •If you have fallen arches and periodically experience pain related to that condition it is a good idea to get custom arch supports to wear in your footwear to prevent the reoccurence of pain and the worsening of the condition. If your fallen arches are genetic but you are not experiencing any symptoms then you probably may not need to seek treatment. In severe cases of fallen arches, surgery may be required to correct the problem. Flat feet have alot of flexibility causing the sole of the foot to become very unstable when on the ground. This can lead to reduced shock absorbancy and subsequently pressure on the joints of the leg and the stress on the muscles trying to control the movement of these joints.
Symptons of Flat Feet
Flat feet can cause a myriad of symptoms. •Pain in the foot, heels, arch, calves, the shin, the knee, the hip and into the lower back due to overworking of the hip flexors. •Standing on the tip of your toes can be difficult.
Treatment for Flat Feet
Using recommended orthotic insoles or running inserts and proper running shoes to ensure the following •Control how the foot hits the ground. •Support the middle of the foot and prevent the arch collapsing. •Promote normal movement in the front of the foot Treatment for all the above problems are often combined with a physiotherapy session in order to help develop a stretching and strengthening programme for the back of the legs and the pelvis in order to allow the return of the normal function of the foot.
A bunion (hallus valgus) is a painful bony bump that forms gradually on the joint at the base of your big toe as a result of abnormal motion, instability and faulty biomechanics.. Pressure on the big toe joint causes it to become misaligned resulting in the big toe pushing towards the second toe. Over time, the normal structure of the bone changes forcing the joint of your big toe to get bigger and stick out. Bunions start out small but they usually get worse over time (especially if the individual continues to wear tight, narrow running shoes. Because the MTP joint flexes with every step, the bigger the bunion gets, the more painful and difficult running can become. Bunions are more likely to occur in people who have unusually flexible joints and that this flexibility may be inherited. An advanced bunion can greatly alter the appearance of the foot. In severe cases bunions can cause the big toe may angle all the way under or over the second toe. Pressure from the big toe may force the second toe also out of alignment causing it to come in contact with the third toe. Calluses may develop where the toes rub against each other causing additional discomfort and difficulty running resulting in the bunion bump. This deformity may gradually increase and making it painful to wear running shoes or to run. In most cases bunion pain is relieved by wearing wider shoes.
Causes of Bunions
? Inherited foot type ? Foot injuries ? Deformities present at birth (congenital) ? Tight or worn footwear may contribute to bunion development.
? Flat feet ? Low or fallen arches ? Foot injuries ? Arthritis ? Inflammatory joint disease
Symptoms of Bunions
? A bulging bump on the outside of the base of your big toe.
? Swelling, redness or soreness around your big toe joint. ? Corns or calluses, these often develop where the first and second toes overlap.
? Persistent or intermittent pain. ? Restricted movement of your big toe if arthritis affects the toe. Although bunions often require no medical treatment, you should see your doctor or a specialist who specializes in treating foot disorders (podiatrist or orthopedic foot specialist) if you have
? Persistent big toe or foot pain. ? A visible bump on your big toe joint.
? Decreased movement of your big toe or foot.
? Difficulty finding shoes that fit properly because of a bunion.
? Certain health conditions, such as arthritis or rhumatoid arthritis and gout which can lead to the formation of bunions causing pain and inflammation in the joints. .
Treatments for Bunions
? Painkillers ? Modifying footwear. ? Orthotic insoles, bunion pads and toe spacers. An advanced bunion can greatly alter the appearance of the foot. In severe bunions, the big toe may angle all the way under or over the second toe. Pressure from the big toe may force the second toe out of alignment, causing it to come in contact with the third toe. Calluses may develop where the toes rub against each other, causing additional discomfort and difficulty running. Surgery may be considered if symptoms are severe and do not respond to non surgical treatment. Icing the area to ease swelling and pain longer for no longer than twenty minutes at a time to prevent ice burn as your foot has less tissue and muscle than other parts of your body. If you have nerve damage or circulation problems, talk to you doctor before putting an ice pack on your feet. Choosing the appropriate footwear after bunions develop is crucial for relieving pain. The best types of shoes will provide enough space for your feet to rest comfortably. They will also provide the necessary structure and support to correct the biomechanical issues that initially caused the bunions. Wearing bunion inserts can also reduce your discomfort and prevent your bunions from getting worse. Special pads can cushion the area near the bunion that hurts. But talk to your doctor first, or test the pad for a short period to see if it helps. If it’s the wrong size for you, it can add pressure and cause more problems. Because bunions are associated with flat feet and unstable arches, bunion shoe inserts and orthotics that provide superior arch support – Tread Labs Stride – will help prevent the development of this painful condition.