Sports conditions and Podiatric conditions each come with their own set of complications. We can help.
Shin Splints or Medial Tibial Stress Syndrome
This is an inflammation of “posterior tibial” muscle that runs on the inside of the calf along/behind the tibia bone. This muscle supports the arch and prevents over pronation or flattening of the arch. This injury is common in a person that has a pronated foot that rolls inward, weakness in the hip and core muscles which allow the knee and foot to collapse inward and sometimes a tight calf muscle. It will continue to get worse if the running activity continues. If left untreated, this injury may progress into a more serious condition in which the covering of the bone called the periosteum gets inflamed or if it continues into the bone a stress fracture can ensue. Early well rounded care is imperative to complete recovery.
Achilles Tendonitis or Achilles Tendonosis with Tears
This is an inflammation of the large tendon behind the ankle. If the problem lingers, it may become a chronic condition which is much more difficult to treat quickly. Often the Tendonitis becomes Tendonosis ( which means chronic irritation and inflammation that could develop into an intra-substance tear) . If the muscles that make up the Achilles tendon are tight or weak, if the foot over pronates, or the hip and core muscles are weak, there is a predisposition to this injury. Early on the symptoms may include warmth and swelling, and can be very stiff in the morning, upon arising, or during or immediately after exercising. Many people will exercise or run through this to later complain of significant soreness later. This is not a good sign. Early aggressive and conservative treatment is important as it may take a long time to rehabilitate and treat.
Runner’s Knee or Chrondromalacia Patella
A truly biomechanical related condition of a misaligned tracking of the kneecap in the groove of the thigh bone called “the femur”. This is usually a result of tight quadriceps, a foot that over pronates, worn out shoes, weak hip and core muscles, all which allows the knee to collapse inward which causes the improper tracking. The kneecap may make some “cracking” or “grinding” sounds, and although alarming, the sounds are usually harmless. Correcting the biomechanical issues is imperative to resolution of this problem. Exercising with this injury is not typically a problem and may not aggravate the issue much, but conservative treatment should encompass correcting all the items listed above, which can prevent further deterioration of the cartilage under the kneecap.
LEG LENGTH DISCREPANCIES
Un-leveling of the hips and pelvis is NOT normal but very common. There are 2 types of Leg length discrepancies; Functional and Structural. Functional LLD is most common, and occurs due to poor foot and body mechanics, weak hips and core muscles, or a scoliosis curvature in the back. Improper posture may also create this issue. Diligent strength and flexibility work, massage, Chiropractic and improving foot mechanics with orthotics or lifts will often correct the deformity and prevent long term dysfunction of the lower back and pelvis. Structural LLD is less common, but occurs from a true difference in the lengths of the lower leg bones (tibia and femur). This may have come from a fracture which caused shortening, or if a joint replacement surgery has changed the lengths of the legs. A lift in or on the shoe of the short side is imperative to reduce any further damage to other joints in the lower extremity or spine.
Illiotibial Band Pain
This large strap like band travels from the outside of the hip down along the outside of the leg and attaches onto the outside of the knee. This band will get injured if it is tight, if the foot over pronates, there is a leg length difference, or there is weakness in the hip and core muscles, which all allow the knee to collapse inward. These things can put increased stretch and tension on the band, where it usually gets irritated down at the knee area. It rarely gets red or hot, but it will be sore with some stair climbing, lunges or running. It will feel better with cessation of running, but as always, treatment should include correcting any misalignment of the hips, and feet, as well as strengthening the leg/hip muscles.
This is a condition that puts stress on the muscle that runs horizontally in the central area of the buttocks. The Piriformis muscle is an outward (external) rotator muscle of the leg, and because it sits on top of the sciatic nerve it may place strain on it like a “tight strap” If the muscle is abnormally tight it can press on the nerve and produce “sciatica” like nerve pains down the leg. Tightness of the muscle, a leg length difference, and a pronated foot are common denominators for this injury. Simple conservative care will easily improve this problem when addressing all the causes of the problem.
This injury is a traumatic twist to any of the three outside ankle ligaments. Usually the typical injury involves the first of the three ligaments. It is imperative that treatment begins immediately after the injury to help guide the ligaments into proper repair, reduce the swelling and bruising. Physical therapy treatments will reduce swelling and pain and improve strength and balance. Proper orchestration of the rehabilitation program needs to be perfect. X-rays may be necessary to determine if there are any fractures present, as subtle injury to bone can occur. Re-injury is extremely common and is the primary reason for re-spraining. All this is typically due to non treatment or improper rehabilitation and immediate care.
These fractures are called the “march” fractures, which are hairline cracks within a bone typically overuse from repetitive trauma, like running. The fracture may be seen on x-ray only after weeks of healing has occurred and bone callus has developed (typically at about 3 weeks). Symptoms will include minimal swelling and no brusing, but developing pain internally in the bone. Typical locations are the metatarsals or the Tibia after a long bout of shin splints. Bone typically takes 10-12 weeks to repair, so this injury takes time to fully heal. Evaluating shoe gear, foot mechanics, training programs and occasionally evaluating bone density for female patients is important. Bone is the one body tissue that heals just as strong as prior to the injury.
This condition may occur from the irritation of the lower back lumbar or sacral nerves that exit out of the spine. Arthritic spurs, a disc protrusion a leg length discrepancy or a foot that pronates may create this problem. Symptoms may include sharp shooting pain into or down either leg with numbness, tingling, burning, muscle spasms. Sometimes deep, very achy muscles in the leg or buttocks can masquerade as a pulled muscle, but is really an injury or irritation to the nerve root . Physical therapy, Chiropractic and massage therapy all work very well, Leg length imbalances and faulty foot mechanics need to be addressed as well. When conservative care fails to relieve the symptoms fairly quickly, a MRI can diagnose damage to the nerve or bony tissues.
Heel Pain or Plantar Fascitis
The thick fibrous band under the foot in the arch is called the “Plantar Fascia.” It tethers the heel to the ball of the foot. Although not typically a serious injury, it will cause pain upon arising from bed or a chair, and can limit athletic and everyday activity. It is probably the most common condition Podiatrist’s treat, so it is very common. Usually increasing ambulation or athletic activity, increasing body weight, or wearing unsupportive shoes are the major culprits to aggravating this diagnosis. Swift and conservative but aggressive treatment is imperative as lingering untreated heel pain may lead to a chronically thickened and scarred fasica band which can even result in a small tear. When the activity continues without treatment it can take a long time to completely heal.
“Metatarsalgia” is an injury to the soft tissues surrounding the small metatarsal joints. The 2nd metatarsal joint is the most commonly injured. The joint can be mildly sore, and the corresponding toe can ache, or if worsens it can become swollen, and very painful. Sometimes the 2nd toe can become unstable and “pop up”. Often there is a bunion deformity present which can destabilize the 2nd joint as it has undue pressures pressing over onto the 2nd toe. For women, this will make high heel walking difficult, and barefoot walking can be uncomfortable too. This problem should be treated quickly with aggressive conservative treatments. Stabilizing the 2nd toe joint while treating swiftly is absoulutely imperative, as ongoing injury may lead to surgical corrections, as the tissue can tear from all the pressure and abnormal stresses.
A “Neuroma” may occur when there is an injury to the nerve that travels between the smaller metatarsals. The nerve commonly becomes pinched due to tight or narrow shoes, it is common in a pronated foot that rolls inward, and the patients commonly has a loss of fat padding in the metatarsal area. This injury is more commonly seen in female patients, proving that women’s tight shoes are a big factor in the development of this condition. Men can experience this injury, so paying attention to shoe sizing is very important. Shoe size can go up with increasing body weight, child birth, continual prolonged standing or years of athletic activities. It is important to make sure to have the feet measured each year for the proper width and length. Athletic shoes should always be larger than dress shoes.
The proper medical term is called “Hallux AbductoValgus” which is an angulation of the large toe toward the second toe. A pronated foot that rolls inward is the common cause, which is typically inherited. This angulation will increase over time, and symptoms may become painful due to tight or poor shoe fit. Many people have bunions without any pain, so conservative treatment to halt the progression, is the way to treat. This includes proper shoes, padding and orthotics to correct the abnormal foot pronation. Although many people have good relief of symptoms, with conservative care, true repositioning and straightening is only accomplished through surgery.
This progressive toe deformity occurs when any or all of the small toes start to flex and curl under. The toe joint becomes prominent and possibly rubs on the inside of the shoe which can result in a corn. This condition occurs from an imbalance of tendons within the foot which creates this cocking up of the toes. Because they are related to faulty foot mechanics, they will progress and get worse, but tight shoes or stockings can contribute to the development. Treatment should include toe padding, and shoe changes, but if they are rigid, the only true treatment is surgery to straighten the joint.
Corns, & Calluses & Blisters
Friction against skin from shoe gear, will cause rubbing resulting in blisters (quick, high frequency friction) or corns/calluses (slow, low grade friction). Prominent bony spots will be the areas that typically get the blisters or corns and calluses. Tight/improperly fitting shoes can cause the friction and increased perspiration which keeps the foot wet can increase the friction causing these rub spots. Typically blister products found at the pharmacy, will protect the “hot” spot and help with reducing the pain. Certain “anti-sweat” socks and/or skin lubrication will help to prevent the friction problem as well. If shoe size is not evaluated properly, the skin can get irritated causing these conditions.