Sports Injuries
Shin Splints (MTSS). Achilles Tendonitis. Peroneal Tendonitis.
Shin Splints
Shin Splints is a term given to a number of common conditions that cause pain and swelling along the inside border of the tibia (shin bone). This collective term can encompass a range of conditions from simple muscle overuse to acute compartment syndrome (which is a medical emergency). The less serious types of shin pain – muscle overuse, periostitis (inflammation of the outer coating of the shin bone where the muscle attaches) are termed (Medial Tibial Stress Syndrome- MTSS).
There are many contributing factors to MTSS but in most cases the underlying cause is repetitive stress to the lower extremity from running and jumping activities, particularly where the onset of pain proceeds a recent increase in training intensity and frequency. MTSS is a very common problem presenting to the podiatry practice. Patients are usually runners who have recently taken up the sport, or recently increased their training volume and intensity in preparation for an upcoming event. We also see the problem in other weightbearing athletes like footballers, soccer players, basketball, hockey etc.
Symptoms of MTSS range from a dull ache to throbbing and severe pain along the inside border of the tibia (shinbone). The pain is usually localised to a defined area of the shin bone and very painful to palpate (touch). In some cases, the area will be visibly swollen and easy to feel. In some cases, imaging (x-ray, MRI) may be helpful in grading the severity of MTSS and managing the acute (inflammatory stage) of the problem, as well as guiding a return to exercise program.
‘At Footwell Podiatry, our experienced podiatrists have treated ALL types of foot and leg problems in the past. Put your feet in good hands’.
How is MTSS treated?
It’s important to take a detailed history and identify the mechanisms of injury. Like most overuse injuries, rest, ice, pain relief, exercise modification, cross training and a team approach to treatment is crucial in a return to exercise. It’s important that we understand the patient’s goals on their rehabilitation journey as this will guide the treatment process.
Following assessment, your podiatrist will work with you in implementing a personalised treatment plan which suits your goals and rehabilitation needs. The usual course of treatment will include the following:
- Rest, exercise modification/cross training
- Strengthening exercises
- Footwear changes/ recommendations
- Custom-made orthotics- changes loads on the muscle/bone and improves mechanical deficiencies
Poor foot biomechanics play a contributing factor to abnormal stress on the inside border of the tibia. Patients with excessively pronated feet (rolled in, flat feet) are more prone to chronic MTSS and will benefit from orthotics and footwear changes to change forces acting on that region of the leg.
Achilles Tendonitis
Achilles tendonitis/tendonosis is one of the most common conditions we see in our clinics. Patients describe pain and sometimes swelling in either the mid part of the tendon and /or at the attachment point of the tendon on the back of the heel bone. Achilles tendonosis is often painful and prevents exercise and often interferes with completion of day-to-day activities. Most patients describe a gradual onset to symptoms with pain localised in the mid tendon and painful to touch/squeeze. During walking, the pain is felt in the ‘toe-off’ phase of the gait cycle when the heel lifts off the ground just before the leg swings through. This condition has multiple causes but the underlying issue is the inability of the tendon fibres to cope with the load placed upon them.
The condition can occur in people of all ages and lifestyles and is common in people commencing walking/running, or any sport following long period of inactivity. In addition we see Achilles tendon issues in athletes who are increasing their volume or intensity of exercise, perhaps ramping up for a future event.
It’s important to take a detailed history and identify the mechanisms of injury. Like most tendon injuries, rest, exercise modification, cross training and a team approach to treatment is crucial to tendon healing and a return to exercise. It’s important that we understand the patient’s goals on their rehabilitation journey as this will guide the treatment process.
Following assessment, your podiatrist will work with you to implement a personalised treatment plan which suits your goals and rehabilitation needs. The usual course of treatment will include the following:
- Rest, exercise modification/cross training
- Strengthening exercises (eccentric loading program)
- Footwear changes/ recommendations
- Taping/kinesio tape
- Shockwave therapy
- Customised orthotics – changes loads on the tendon and improves mechanical deficiencies
Peroneal Tendonitis
Peroneal tendonitis/tendonosis is a painful condition causing pain and swelling about the two peroneal tendons as they track behind the outside of the ankle bone. Patient will often report a gradual increase in pain as they increase their volume and/or intensity of exercise. In certain foot types like high arched, rolled out, and in people with hypermobility issues (flexible joints), even normal day-to-day activities can elicit symptoms which can become chronic in nature. This painful overuse problem commonly goes under treated as the mechanical factors to tendon overuse/damage are subtle and often go overlooked. Podiatrists are the best trained to conduct a biomechanical assessment (often with video) and identify the small mechanical problems that lead to tissue stress and pain.
The peroneal tendons plantarflex and evert the ankle. The latter, eversion, prevents the ankle from rolling out and spraining. In people with very high arches (naturally rolled out feet), or people who are hypermobile (very flexible joints), the peroneal muscles/tendons work harder than normal to prevent the ankle from spraining (rolling out) with each step that is taken. This in turn causes tissue damage, pain and swelling.
Conducting a video gait (walking) assessment (better with video) is imperative in identifying the small biomechanical problems that lead to peroneal tendon overuse. Often the degree of supination (rolling out) is subtle and can only be seen on slow-motion video analysis. Even people who have pronated (rolled in) flat feet can supinate (roll out) in the few milliseconds after their heel contacts the ground in the gait (walking cycle). It’s a little counterintuitive and unless you know what you are looking for it can go undiagnosed.
A biomechanical examination is helpful particularly when the injury is reoccurring. Core stability issues and foot mechanics issues can be a factor in re-injury and are easily rectified.
Following assessment, your podiatrist will work with you to implement a personalised treatment plan which suits your goals and rehabilitation needs. The usual course of treatment will include the following:
- Rest, exercise modification/cross training
- Strengthening exercises (eccentric loading program)
- Footwear changes/ recommendations
- Taping/kinesio tape
- Shockwave therapy
- Customised orthotics – changes loads on the tendon and improves mechanical deficiencies
Managing the acute phase of the condition is important to reduce pain and inflammation. This is done with rest, ice, compression, taping and cross training (cycling instead of running for example). Custom made orthotics are the main treatment option in managing the chronic presentations of this condition. Be careful though as orthotics for this condition need to be wedged the opposite way to normal (wedged in to pronate-roll-in your ankles) so they will need to be custom-made. NOTE- there are no off-the-shelf premade orthotics or shoes that will help this condition. They will often exacerbate symptoms!
