Shin Splints – How we Help Get Rid of Them

Shin Splints (Medial Tibial Stress Syndrome)

This one has the ability to stop you mid-run. That horrible pain in the shin that gets worse as you go and is almost impossible to “run through.”

Shin Splints or Medial Tibial Stress Syndrome as they are known medically are pain that occurs typically in the front of the shin bone (lower leg) but can also occur in the back of the leg.

They most commonly occur in runners but also in people ho have increased their weight bearing activities quickly without properly preparing their body for the work load.

They occur when the periosteum (tissue coating the bone to allow muscles to attach), is placed under an amount of stress that they are not equipped to cope with.

In severe cases the break down of tissue can result in a tibial stress fracture. A more serious condition which puts you out of weight bearing activity for a couple of months.

Can a Podiatrist Help?

Podiatrists are the primary health carers for the lower limb and are perfectly placed to help you get over shin splint pain.

We know the anatomy and the physiology that contributes to shin splints occuring in the first place and are trained in the best techniques for reducing the pain involved in the short and long term.

By assessing your particular circumstances a Podiatrist uses their experience and technology to get to the root of the problem.

First we listen

One of the msot critical factors in treating a problem like shin splints is to find out exactly what conditions caused it.

By conditions I mean, what exerise, work and other activities has the patient been doing over the past couple of months or even years which may have contributed to the condition?

It is only once we understand the mechanism of the injury that we can start taking steps to help you recover from it and prevent it from reccuring.

 

Then We Examine

Then we start to assess what is going on when you move to get a better understanding of how the injury occurred.

That gives us a great chance of knowing what will help 

Three podiatrists analysing some information on a screen

Range of Motion Studies

Then we start to assess what is going on when you move to get a better understanding of how the injury occurred.

Range of motion studies are performed to see if there are any restrictions in your joints which may have caused other parts of your body to overcompensate. E.g. a very stiff ankle may mean that the middle of your foot (mid-tarsal joint) has to flex more to allow you to move forwards. This in turn puts more strain on the tendons and muscles (including tibialis posterior, flexor hallucis longus and flexor digitorum longus)  in your leg which can lead to shin splints.

Muscle Testing

We test the strength in all your muscle groups to see if there are any imbalance there which could lead to some muscles having to work much harder.

Gait Assessment - The Big One!

Finally and often most importantly we assess your gait – this is a huge one because we are looking at exactly what actually happens when you move. 

 

The legs and feet of someone walking on a treadmill with a screen in the background

Using our Sensor Medica Treadmill we are able to take high speed video and slow it right down, and couple that with pressure analysis, thereby knowing exactly what forces are going through which parts of your feet at which stages of the gait cycle.

This treadmill is state of the art and provides a level of insight that is far beyond what we previously had access to.

Treatment of Shin Splints

Obviously all this examining means nothing if we don’t have ways to get you better and back enjoying the activities that you love, and that will keep you well into your later years.

Once we find a biomechanical factor that could be contributing to your pain such as tight muscles, muscle strength imbalance, over rotation of the foot and ankle, poor shock absorbing capabilities or compensation for a problem higher up the leg, then we test our theory.

Often we will try some soft wedging in your shoe or strapping your foot and ankle to see if altering the forces on the painful areas will result in less pain. If it does this is a great indication that we are on the right track.

Once we know what will work we can begin putting it into practice.

Treatment Techniques

Footwear Advice

Footwear will often be the first thing we look at because it is often an easy win.

Often runners will be sold what is considered to be the “ultimate running shoe.” Unfortunately not everybody is suited to the one shoe type.

The highest end of the running shoe range will usually be a shoe that is wedged on the inside to prevent pronation. But if the runner has a more supinated (turned out) foot type, then this type of shoe can be really problematic.

It can tip their foot and ankle out even further causing a lot of tension on the peroneal muscle group (those muscles on the outside border of the lower leg that stabilise the ankle.

The other obvious one is when the shoes are past by their use by date and are now causing problems because the outsole or the mid-sole is worn out.

Stretching and Strengthening:

We often find that people with shin splints will have inbalances in their muscle groups.

 

Typically one group e.g. the flexors may be too tight, and another group e.g. the extensors are too weak.

This imbalance causes increased tension on tendons which attach to the tibial periosteum (bone coating) and can cause pain.

So we prescribe strengthening for the weak muscles and stretching of the tight muscles.

This therapy will usually have some quick results, but takes a couple of months to notice the full balance.

A woman doing a single leg calf raise

We often find that people with shin splints will have inbalances in their muscle groups.

Typically one group e.g. the flexors may be too tight, and another group e.g. the extensors are too weak.

This imbalance causes increased tension on tendons which attach to the tibial periosteum (bone coating) and can cause pain. 

So we prescribe strengthening for the weak muscles and stretching of the tight muscles. 

This therapy will usually have some quick results, but takes a couple of months to notice the full balance.

Soft Tissue Therapies

We have several options in our treatment arsenal that work on the soft tissue causes of shin splints. Most of them will usually be carried out in conjunction with some kind of orthotic therapy , because if used on their own, the soft tissue will quickly go back to its previous state once you walk out our door.

These therapies include:

  • massage,
  • dry needling (using fine acupuncture needles to release trigger points in tight muscles, 
  • foam rollers and trigger balls – used at home as a method for stretching tight muscles and working on trigger points, – sometimes we will refer you to a physiotherapist if we think you need extensive soft tissue therapy or shockwave treatment done,
  • Custom arch supports or foot orthotics – I will go into this further below.

Custom Foot Orthotics

This is the biggest weapon we have in our war on your shin splints.

To find out more about how our orthotics are made click here.

Custom foot orthotics are the best way to reduce undue stress on the soft tissues that cause shin splints (medial tibial stress syndrome).

A custom foot orthotic with an aqua coloured background

Contrary to popular beliefs that foot orthotics force your foot into a “better or normal position,” what they really do is facilitate the most efficient and least stressful motion as you walk or run.

We achieve this by using our advanced assessment techniques mentioned earlier in this article to drive our prescription for custom foot orthotics.

We work out where there are blocks in your motion such as tight muscles and restricted joints and design an orthotic that will help your feet and ankle to move more effectively and also reduce some of the unnecessary movement.

This helps to conserve your energy and can significantly reduce the tension and stress placed on soft tissue structures which is causing the pathology (pain and damage).

3D Laser Foot scanning at Dynamic Podiatry

After we have determined the correct prescription for you, we use our three dimensional laser scanner to take super accurate scans of your feet and they then get sent to the orthotic lab where your custom orthotics are made.

 

We then fit your orthotics to your shoes and do another gait analysis to make sure eerything looks right, and then you wear your orthotics in slowly.

After three weeks of wearing your orthotics we get you back into our clinic for a free orthotics review appointment where we make sure that you are able to wear them all day and that the pain is starting to ease.

We don’t expect all pain to go away immediately but it should at least be heading in the right direction. Any problems are ironed out in this visit.

We want you to have total satisfaction in your custom foot orthotics.

Sometimes the orthotics may need a little tweaking at this time to make sure they are doing what we want them to.

 

In this photo the patient (me!) is seen running barefoot in the top photo and running with shoes and orthotics on in the bottom photo.

In the top photo you can see a large bulging on the inside (medial) of the ankle demonstrating a lot of pronation.

Pronation is the body’s natural shock absorbing mechanism so we don’t want to remove it.

What the orthotics and shoes do here is prevent excess pronation – which leads to extra tension on the tendons on the medial side of the ankle – one cause of shin splints.

Two images of a lower leg and foot on a treadmill showing one without shoes and one with shoes and orthotics. The difference is in how much the orthotics prevent excess flattengin of the arch.

By allowing the foot and ankle to pronate a lesser amount, there is much less strain and stress on the soft tissues supporting the feet and ankles, and the body is able to propel itself forwards much more efficiently.

Dynamic Podiatry Team

If you have shin pain which is ruining your enjoyment of walking, running or any other weight bearing activities, call us for an assessment with one of our experienced podiatrists on 3351 8878.

Or book online by clicking here.

Important: The information contained in this article is general in nature and does not substitute professional advice.

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