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A Patient with Shin Splints at the Sydney Podiatrist Clinic
At the Sydney Podiatrist clinic there are a variety of medical conditions that affect the lower leg. One of these common conditions affecting runners and people from all walks of life is shin splints. This condition can affect one or both legs at the same time and can be quite painful during physical activity. More often than not, the runner will report that after warming up the pain in the shin reduces significantly and he or she is able to complete his run. Once a patient visits the podiatrist in Sydney where we have a gait laboratory with a full sized treadmill, we are able to cut carry out bio mechanical assessments in order to determine the cause of the condition. Other practitioners that treat shin splints are physiotherapists, sports medicine doctors, chiropractors, osteopaths and acupuncturists.
In March 2018, a 35 year old male presented to the podiatrist in Sydney, Martin Place complaining of shin splints in both legs. He had been feeling this pain for more than 12 months and had seen several medical practitioners in order to try and get on top of this chronic condition. Apparently, this particular patient had been to see one other sports podiatrist in Sydney and had received a variety of treatments.
Shin splints is a generic term used to describe a variety of ailments affecting tibia and the muscles and tendons that originate from the bone itself. One of the common pathologies is known as tibialis posterior tendonitis. This condition involves inflammatory change and irritation to this muscle origin or the tendon as it wraps around the ankle. This particular patient described symptoms of tibialis posterior tendonitis which would affect him for the first 3 km of his 15 km run. He would also report ankle pain when climbing hills or walking up stairs. This patient was under the care of a previous podiatrist in Sydney, and he received Shock Wave therapy, dry needling, and stretching techniques. The sports podiatrist did not recommend a specific type of running shoe nor did he prescribe orthotics. The patient reported that his calf range improved and his ankle felt more free, but his symptoms persisted. The next morning after completing a 15 kilometre run, the patient reported to the sports podiatrist but he felt significant pain for the first 5 or 10 minutes of activity. Following his morning shower and some general walking around the house, the patient reported some improvement in symptoms. This gentleman also went to visit his GP who prescribed Mobic, which he used for approximately 3 weeks. Following some stomach irritation, he decided to stop taking the tablets and his symptoms returned. There was approximately a 50% reduction in symptoms during the use of these anti-inflammatory tablets. This patient also reported to the sports podiatrist that the use of soft ice packs and compression around the ankle were extremely beneficial although short lived.
Biomechanical Assessment at the Sydney Podiatrist Clinic
The sports podiatrist, Sydney, decided to carry out a biomechanical assessment with the patient running on a treadmill without shoes. The typical anatomical landmarks were highlighted using black texter, and the patient walked, ran and jogged on the treadmill for approximately 4 minutes. Video footage was captured and replayed in slow motion which allowed to sports podiatrist to detect bio mechanical anomalies. The sports podiatrist also assess the patient running with his Asics DS trainer.
The sports podiatrist also carried out foot posture index measurements with the patient standing in a neutral and a relaxed calcaneal stance position. Arch heights were measured and calcaneal eversion was also measured. Knee to wall measurements were taken to assess the range of motion through the ankle joint, allowing assessment of calf muscles. The patient was also requested to perform single leg heel raises on both feet. The patient was asked to perform repeated raises until exhaustion and the total number of raises for each leg was noted.
What did the Podiatrist, Sydney, Find?
When performing the single leg heel raises the sports podiatrist, Sydney, observed that the patient was able to perform approximately 35 raises using his good foot. However, when attempting to perform heel raises on his symptomatic foot the patient was unable to perform more than 3, and he experienced significant pain during this exercise. The podiatrist was also able to observe significant joint hypermobility throughout the knees ankles and joints of the feet. This joint hypermobility causing significant over pronation through both feet. This over pronation was apparent when running barefoot, and was even more severe when running with the soft, flexible, Asics DS trainer. Due to this ligament laxity, the podiatrist also noted extreme tightness through the gastroc and soleus muscle groups, as they were attempting to compensate for the ligament weakness.
Treatment Plan by the Podiatrist, Sydney
Primarily, the podiatrist, Sydney, informed the patient that it was crucial he changed his running shoes. He was informed that the Asics DS trainer is a very lightweight shoe providing minimum stability or support. The patient was advised that he would be much better off running in an Asics 2000 or 3000, or even the GEL-Kayano. The patient was advised to perform calf stretches 3 times per day and was given strict instructions as per the technique. The podiatrist advised the patient that calf range was an important factor in the rehabilitation of many foot and ankle conditions. The sports podiatrist also applied rigid sports tape to both feet in order to give the foot more stability and support. The patient was informed that the strapping should stay in place for approximately 5 days before being changed. The patient was advised to refrain from running for 2 weeks, and would be reviewed at this time.
The patient was advised that if he did not improve then careful consideration would be given to the use of prescription orthotics, which would realign the rearfoot and provide additional support inside the shoe. The patient was advised that the soft gel liners that come with running shoes do not provide support, but moreover they provide cushioning. Patients with hypermobility often benefit more from stability as opposed to cushioning.
2 Week Follow Up with the Podiatrist, Sydney
This patient returned to visit the sports podiatrist, Sydney, 14 days from his first appointment. The patient reported that he had been diligent with calf stretching and the application of soft ice packs. He had purchased the Asics 3000 running shoes and had been using these to walk. He had not run. He reported 50 percent reduction in pain when getting out from his bed each morning. He also reported an improvement when walking up hills and when climbing stairs. To this end, the sports podiatrist decided to continue with the same treatment and review the patient again in another 14 days. After 4 weeks the patient reported that he was almost pain free. The podiatrist in Sydney, Martin Place was happy with this progress and inform the patient that she should start to exercise gently. The patient was advised to walk, jog, walk, jog for a short 2 kilometre distance. Pain levels were monitored and the frequency and distance was increased gradually. After 8 weeks the patient reported to the sports podiatrist that the pain level was minimal, and that he only felt stiffness through the medial side of symptomatic ankle. He was able to run for six kilometres without the symptoms returning. The patient was discharged from the clinic and was advised to continue with his reintroduction to the training program and only return to the podiatrist, Sydney if his symptoms deteriorated. Once again he was advised that the use of carbon fibre prescription orthotics may have a place, should his symptoms return. Rigid orthotics with padding, provide the support that loose foot ligaments do not have. The patient was advised that it is a genetic predisposition that causes loose ligaments, and that we are unable to strengthen ligaments.
Please note that the information contained in this case study is specific to one particular patient who came to see the sports podiatrist in Sydney. If you think you have shin splints or any other foot and ankle problem you should consult with a suitably qualified Sports podiatrist.
Sports podiatrist, Sydney – Karl Lockett.