Archive for the ‘Leg pain’ Category

HOKA ONE ONE Bondi 3 Shoes

20150219_221408

I want to give you my take on the Hoka Bondie 3 shoes I purchased from Ragged Mountain Running shop a couple weeks ago.  I have a very broad background in running. In high school, I made the All American Track and Field team, competed at the Kinney Cross Country National meet (known now as Foot Locker Nationals), and attended college on a full scholarship.  However, after injuries and many years away from any kind of training, my return to running has proven to be difficult and painful. My runs now are not much more than a jog.

I’ve been trying to implement running as a supplement to my cycling training for months now. Knee pain, however, has crushed my motivation to do so. This winter’s cold and snowy weather has been brutal on my cycling training.  Riding a bike in 20+ degree weather against the cold wind, well, just ruins the fun of biking for me. The answer, put my running shoes on and suffer through the pain.

I’ve read and heard great things about the HOKA shoes. I also learned they are not cheap, $130.00+. I really wanted to try a pair, but thought it would be a waste of money. How could a shoe make that much of a difference? Maybe people are writing positive reviews to help justify to themselves the amount of money they spent. After a couple months, I had to try something.

Walking around the shop in several different models of the Hoka brand, I felt what many people had written about in their reviews. Walking on a cloud is the best way to put it.  I thought, this is neat, but I’m not sold and it seems gimmicky. Do I really want to spend money on these?

I should also mention, my first answer to my knee pain was to not run on the pavement. Throughout my running career, I ran on grass and gravel to stay away from injuries. However, these days I find myself lazy and only finding the motivation to run straight from my house where the only option is pavement.  I need lots of cushion and the Bondi 3s seems like a good gamble.

My first run in the Hoka far exceeded my expectations.  I only had time for a couple miles, but that’s all it took for me to fall in love with these shoes. I had no knee pain the first day, nor the following several days.  I’ve been running almost every day now for two weeks and my legs, although tired, are still pain free. This experience couldn’t have come at a better time. The several inches of snow recently have kept me off the bike, but not out of my Hokas.

20150219_221431I will follow up with this post over the next few months to let you know how the Bodi 3s perform. The only possible issue I see so far is that the mid foot area of the bottom sole seems to have a very soft compound rubber and therefore, may not be very durable.

Mark Smith

Custom Functional Orthotics

Custom orthotics are the best decision people can make to improve their foot health and function. Custom orthotics are unique and specially made to your feet.  Orthotics treat and correct individual foot ailments. Proper shoes fitted with custom foot orthotics are the best insurance that we can give ourselves to protect our feet.

Your orthotics are manufactured by a state-of-the-art fabrication facility utilizing the latest advancements in machinery and technology available today.  The fabrication starts with an analysis of your feet and a laser casting.  The image produced from this scan is sent to our lab where your device is “born”.  The technicians analyze these scans and make subtle adjustments to ensure a precise fit and form. Exact models of your feet are created on an automated CAD/CAM milling machine.  These models are used to form your orthotics with a high temperature pressure fit system.  Then they are assembled by hand and laminated.  The result is a set of orthotics made to your feet with Dr. Murray’s or Dr. Chang’s specific instructions and modifications to optimize your foot function.  This process typically takes 2 weeks and you will be called when they are ready.

Please bring the shoes you plan on using the orthotics with so one of our assistants can check for a proper fit. You will be given instructions to use with the orthotics during the “breaking-in” period. A follow up appointment will be made to discuss with the doctor how the orthotics are working for you. Some patients may need more time to get used to their orthotics and some orthotics may require adjustments.  Although most patients are happy with their devices immediately, we want you to appreciate the uniqueness of the human body and understand this process can sometimes take time to make the proper adjustments. Our goal is to help treat and correct your ailment so you can live a healthy and active lifestyle. Therefore, we include free adjustments for 90 days.  

One set of orthotics may suffice for many of our patients, but different activities require different accommodations. Therefore, some of our more active patients order multiple pairs of orthotics. Here are a few of the reasons why:

Custom Orthotics by Blue Ridge Foot and Ankle Clinic

Blue Ridge Foot and Ankle Clinic Custom Orhotics

I need a second set of orthotics for when my other pair gets wet.” – Local runner

I need orthotics for standing on a concrete floor all day and another pair for hiking with my family.” – Factory worker

My orthotics really help in my athletic shoes. I wish they worked in my dress shoes.” – Local business woman (we offer the Cobra, which is an orthotic designed to work with many casual and dress shoes)

Most of our orthotics are designed to last 5 to 10 years. Depending on your particular ailment, activity, and amount of use, your orthotics may need to be refurbished (re-covered) during this time period.

Cost:

First set – $395.00

Additional set – $300.00

Refurbishment – $75.00

These are the prices for non-covered orthotics; when covered by insurance, the prices are predetermined by the terms of the insurance plan.

Insurance coverage: Please verify with your insurance company that custom orthotics are a covered benefit and how your deductible and coinsurance apply.

Welcome to the Blue Ridge Foot and Clinic team. We look forward to helping you stay healthy and active.

 
Blue Ridge Foot and Ankle Clinic
 
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887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
New office in Fishersville will open early 2015 @
66 Parkway Lane Suite #102
Fishersville, VA 22939
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
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We Offer Custom Functional Orthotics

September 22nd, 2014 by Dr.Chang

Orthotics are commonly suggested aides to recovery and injury prevention. Orthotic shoe inserts control the motion between the forefoot and the rear foot, evenly distributing the weight and pressure exerted on the foot. They reduce excessive motion that may occur in certain feet, they can act as a binding force that absorbs strain as pressure is exerted on them, and they can accommodate and cushion painful or injured areas. “While not everyone needs orthotics,” Dr. Murray notes, “they are a highly successful conservative treatment strategy for certain types of feet and foot conditions.” For problems ranging from structural deformities, such as bunions, to conditions such as posterior tibial tendonitis, orthotics are an economic way to both treat pain and prevent further injuries.orthotic pic reduced

Through their forty years of combined experience in working with Charlottesvillian feet, Dr. Murray and Dr. Chang have found resounding success in prescribing and fitting orthotics to fit a variety of foot types and injuries. The process for getting orthotics takes some time, primarily because Dr. Murray and Dr. Chang want to make sure that orthotics are right for the health of your feet.

If you suspect that you need orthotics or if you have foot pain, a first visit will include a foot examination, as well as an examination of your shoes. That’s right, bring your shoes to your appointment. The reason being is that the number one cause of foot pain and related injuries is worn out shoes. “Shoes are just not made to be worn forever,” comments Charlottesville shoe guru, Mark Lorenzoni of Ragged Mountain Running. Lorenzoni, a veteran runner and long-time shoe salesman, argues that you should be just as wary of your daily shoes as you are of your athletic shoes. Shoes should be sized properly in regard to the width of the different parts of your foot as well as your gait, your arch, and any propensities your foot may have to pronate. Shoes support your foot by guiding its motion.

If you did not consider which shoes are best for your individual feet, or if you wore out your shoes and kept using them, you may be experiencing a host of problems. Shoes that are too loose can cause blisters or problems with your Achilles tendon; shoes that are too tight could cause plantar fasciitis or aggravate bunions and bursitis; shoes too wide could cause problems in the ankle of people who pronate, and shoes too tight could cause ankle pain in a supinator. So if you come in telling Dr. Chang and Dr. Murray that you have kept working out in over-worn or ill-fitted shoes, they may just send you back to Lorenzoni’s shop. There, a number of trained shoe experts will conduct a gait analysis and draw on their years of expertise in the industry to match your feet to the proper shoe. And a time-saving strategy may be just trying new shoes and replacing your shoes every 200-400 miles, according to the chart below. The good news is that purchasing new shoes is often a complete solution to burgeoning foot pain! The shoe mileage chart below, created by the family at Ragged Mountain Running Shop, can help you sort out when to replace your shoes.

Shoe Mileage Chart

Over half the injuries runners and walkers experience can be directly attributed to “worn out shoes”. Worn out refers to the midsole (engine) of the shoe, which is the most important component of an athletic shoe. Don’t use the outsole/tread wear as a way of determining how much life is left in your shoes! This midsole component generally lasts about 375-450 miles of athletic use. Cut that mileage rating in half if you choose in addition to use your shoes for anything other than your running or walking exercise (i.e. “wearing around”). Here is a sample mileage chart to determine how often you might need to replace your exercise shoes.

Exercise miles/week5 miles/week10 miles/week15 miles/week

20 miles/week

25 miles/week

30 miles/week

35 miles/week

40 miles/week

50 miles/week

When to replace shoesEvery 18 months-two yearsEvery 10 months-1 yearEvery 6-9 months

Every 5-7 months

Every 4-6 months

Every 3-4 months

Every 3 months

Every 2.5-3 months

Every 2-2.5 months

*Created by the family at Ragged Mountain Running Shop*

New shoes, however, may not solve all your foot pain. If you still feel pain after you try out your spiffy new, well-fit shoes, it is time to visit your Charlottesville podiatrist. To get closer to the root of your foot pain problem, Dr. Murray and Dr. Chang are likely to suggest that you wear an over-the-counter shoe insert for a couple of weeks. These inserts cost between $35 and $60, and test whether your foot needs a little extra support or more specific support from an orthotic. If pain still occurs, upon the next visit Dr. Murray, Dr. Chang and their staff will assist you with taping your foot. The tape, in addition to the over-the-counter shoe inserts, will help to redistribute weight throughout the whole foot, binding it in a way similar to an orthotic to test whether a pair of custom-made orthotics will help you. Orthotics last about 5 years (depending on use), they lessen the likelihood of injuries, reduce doctors visits, and relieve pain.

The prescription for your orthotics will depend on your foot type, your condition or injury, and the intended purpose of the orthotic. To this effect, there are different kinds of orthotics. Orthotics are mainly grouped into two categories: functional and accommodative. Functional orthotics correct for excessive motion of the foot, preventing pain during ambulation. Accommodative orthotics are used to distribute weight away from a painful or injured area. Dr. Murray and Dr. Chang will scan your foot and write a customized prescription for your orthotics to fit your orthotics’ purpose and your intended activities. They will consider materials used, the rigidity of the device, and the shape of the heel or head to ensure you go home with the right product.

The process to begin wearing orthotics is gradual. It takes 2-3 weeks to work up to wearing an orthotic full time since the adjustments they make with your foot function could cause initial soreness or pain in the feet, ankles, knees or hips. It takes several months before athletes can run in orthotics comfortably. Be attentive to any pain that may surface in the initial weeks, as adjustments to your orthotics are free under a six-month warranty with the lab that makes them.

IMG_1762But it all comes back to shoes. Truth be told, orthotics are only as good as the shoes in which they are inserted. Make sure that your footwear is foot-friendly and accommodates orthotics. It is important to recognize that worn out shoes will negate the work of the orthotic. Note that not all shoes are made to accommodate orthotics, no matter the brand, style, or cost. Consult your podiatrist or local shoe store for more information on which shoes are compatible with orthotic devices. Although one pair of orthotics can be used in multiple pairs of shoes, most patients purchase multiple pairs of orthitcs to fit a variety of shoes.

As sand and dirt can abrade them, reducing their functional period, wash your orthotics every two weeks with mild soap and lukewarm water, letting them dry overnight before reinserting them. If you find that your orthotics squeak, remove them from your shoes and sprinkle talcum or baby powder on them, which should prevent the squeaking.

Your orthotics will work to restore your gait, posture, and to prevent a host of injuries that could be caused by your foot condition. Orthotics are affordable and last for years, and prevent a host of conditions, from runner’s knee to lower back pain. They are a highly effective, cost efficient, non-invasive, and all-around successful treatment technique. Orthotics are only helpful when used, so Dr. Murray and Dr. Chang suggest that you wear orthotics continually to reduce pain and to improve your posture and alignment.

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Blue Ridge Foot and Ankle Clinic
 
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 
417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
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sm100-logo-400

Blue Ridge Foot and Ankle Clinic’s employee, Mark Smith, had a strong showing at the Shenandoah Mountain 100 mountain bike race this past Sunday (watch). This was Mark’s first attempt at a 100 mile mountain bike race.  Racing for the Charlottesville Racing club/Blue Ridge Cyclery p/b Reynolds GM Subaru, he completed the course in 8 hours and 39 minutes, placing him 35th out of over 500 competitors.

“I’ve been wanting to compete in this race for a couple years now, but injuries kept me from participating”, says Mark.  Finally injury free, Mark was able to get a last minute entry to the race. Mark admits, “I have not been this nervous about an event in a very long time. All my friends and fellow competitors were giving me advice and it was making me more and more nervous.” Once on the starting line, the familiarity of racing calmed his nerves and the race was on. “100 miles of fun!” Yeah um, maybe for you Mark.

“All joking aside, this was a very hard race that tested every aspect of my biking skills. I didn’t want to get stuck in traffic, so I went out fast, too fast. 45 miles in, I had a hard time communicating with the volunteers at aid station 3. Luckily the volunteers were on the top of their game and just took care of me: food, drink, and a shove off in the right direction.”

Mark ran into hard times before reaching aid station 4 around 60 miles. A bad headache caused him to slow and have a hard time keeping his bike on the trail. Disappointment set in as he sat at aid station 4  with a cold wet cloth dripping water over his head and watching other racers ride by. “I was dizzy and in a lot of pain. I even contemplated dropping out.” After 10-15 minutes, Mark decided to just get on his bike and pedal slowly to the finish, well at least try to.

Approximately, 10 miles later Mark’s headache started to dissipate and he started to feel much better. “I couldn’t believe it. I couldn’t explain it. It was like my body did a complete 180.” For the last 30 miles, Mark, “put the hammer down”. Fellow riders warned him about the difficult climbs still remaining, but why slow down when you feel this good. “I felt great and was climbing stronger than I had all day. Maybe it’s the strength I developed on my back to back 100 miles to Georgia or with my teammate Barry Pugh.”

First 100 mile mountain bike race completed. When asked if he will do it again next year, Mark had this to say. “YES! I not only learned a lesson about staying in the race and finishing, I also had a blast. The whole weekend was fantastic. Chris Scott of Shenandoah Mountain Touring and all of the really helpful volunteers made this event one of my all time favorites. The trails were so much fun and at times extremely challenging. The climbs were long and hard. The competition was crazy good. Yes, these are the things I enjoy about racing. I love pushing myself and can’t wait till next year.  Oh, tell Dr. Chang the custom carbon orthotics he made for my cycling shoes did great. I had no foot pain whatsoever.”

Great job Mark.  See race results here, SM100.

Follow up note: 
Mark’s calves became very sore and tight a couple days after this race. Dr. Stewart Chang treated his calves with Extracorporeal pulse activation treatment (EPAT) Wednesday. We are happy to report, Mark’s calves were immediately better and he is back on the bike.
Athletes who need to stay consistent with their training should consider EPAT. Read about EPAT on this site or call us today. 

Click here for a free book offer.

 

Blue Ridge Foot and Ankle Clinic
 
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 
417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
rsz_running_card

cycle

Common cycling injuries are often due to trying to do, “too much, too soon”, but may also be due to improper equipment, biomechanics, technique, or bike fit.  As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.

Foot Pain

1. “Hot foot” (numbness and burning in the ball of the foot)

Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling which results in numbness, tingling, or burning, or sharp shooting pains into the toes.  Loosening shoe toe straps, wearing wider shoes with a stiffer sole and using anatomical footbed with a metarsal pad will help alleviate the problem.

Besides tight shoes, another risk factor is small pedals, especially if you have large feet.  Small pedal surfaces concentrate pressure on the ball of the foot.  Switching to larger pedals may be the cure.  Re-focus the pressure on the ball of the foot by moving the cleats towards the rear of the shoe.  If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.

Physician-designed custom orthotics provide biomechanical benefits and can be made with built-in “neuroma pads”.  Cycling orthotics are different than those for runners, as cycling is a forefoot activity, not a heel-strike activity.mt climb

Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.

2. Sesamoiditis:

The sesamoids are two small “seed-like” bones found beneath the big toe joint.  Injury to these tiny bones can result in inflammation or even fracture, leading to debilitating pain and inactivity. Sesamoiditis can be relieved with proper shoe selection, accommodative padding, and foot orthoses.

Leg Pain

1. Achilles tendonitis

Irritation and inflammation of the tendon that attaches to the back of the heel done can be caused by improper pedaling, seat height, lack of a proper warm-up, or overtraining.  This condition is usually seen in more experienced riders and can be treated with ice, rest, aspirin, or other anti-inflammatory medications.  Chronic pain or any swelling should be professionally evaluated.  Floating pedals which allow excessive foot pronation may also worsen this condition.

2. Shin splints

Pain to either side of the leg bone, caused by muscle or tendon inflammation, which may be related to a muscle imbalance between opposing muscle groups in the leg.  It is commonly related to excessive foot pronation (collapsing arch).  Proper stretching, changing pedals, and corrective orthoses that limit pronation can help.

Knee Pain

Some intrinsic knee problems like swelling, clicking, or popping should be immediately evaluated by a sports medicine specialist.  Cartilage irritation or deterioration, usually under the knee-cap, can be caused by biomechanical imbalance, improper saddle height, or faulty foot positioning on the pedals.  Riding in too high a gear “mashing”, excessive uphill climbing, or standing on the pedals all may aggravate the problem.  Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees, feet, and pedals are misaligned.

1. Chondromalacia

Pain under the kneecap.  Most chondromalacia sufferers can ride at some level no matter how sever the degeneration.

2. Patellar Tendonitis

Strain of the tendon which attaches the kneecap to the leg, this injury often occurs in the novice cyclist or early in the cycling season.  The first sign of a problem may be an ominous twinge after cycling in too hard a gear.mark_1

Cycling tips

Bike fit is key; have a professional check your fit and make bike modifications as needed.

Carefully choose the shoes you will wear in cycling.

Train properly using adequate warm-up and cool-down. If you are doing “too much, too soon” and start having pain, reduce training frequency, intensity, and time.

Pain is not normal and may indicate a medical condition. Seek medical attention from a sports medicine specialist.

Before beginning any exercise program, be sure to check with your physician.

-The American Academy of Podiatric Sports Medicine (AAPSM)

 

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro, VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years.  Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming
you to our practice.

Achilles Tendonitis

March 27th, 2013 by Dr.Chang

achilles     If you are experiencing achilles tendonitis, you are not alone. In the United States, there are an estimated 250,000 sports-related achilles tendonitis cases per year. Many of these cases arise from nagging, and often neglected, pain in the back of the ankle. This blog will provide more information about achilles tendonitis: what it is, why can it cause recurring pain, and how can you work to prevent and heal your achilles tendonitis.
     The achilles tendon is a band of tissue that connects your calf muscles to your heel bone. When your calf muscles contract, the achilles tendon enables your heel to rise. Likewise, it helps decelerate your foot as it hits the ground during walking, running, or jumping, incurring a lot of impact while doing so. In fact, the achilles tendon can take on a load up to 4 times your body’s weight during a running or jumping activity! The achilles tendon is an active an crucial component of any standing movement or activity.
     There are different types of achilles tendon disorders and injuries. Achilles tendonitis is caused by the breakdown of the achilles tendon, which leads to inflammation and micro-tears in the tendon itself. When your tendon tears at a rate faster than the body can heal it, achilles tendonosis occurs, which is a chronic and irreversible tearing and inflammation of the tendon. Other achilles injuries include tenosynovitis, an inflammation of the tissue sheath that surrounds the achilles tendon, which can occur with, or lead to, chronic problems and irreparable tears in your achilles tendon. Retrocalcaneal bursitis is another commonly occurring achilles disorder, an inflammation of the fluid-filled cushion, called a bursa, under the achilles tendon. And, finally, an achilles rupture is a partial, or often complete, tear of the tendon.
     Most frequently, achilles tendonitis is a progressive injury, with a gradual onset due to overuse rather than being caused by a specific traumatic injury. It can be caused by weakness or lack of flexibility in the calf, or weakening due to age, and, most likely, by repetitive stress on the tendon and calf muscle. Achilles tendonitis is common among weekend warrior athletes, runners who have suddenly increased their mileage or increased it too quickly, or other athletes, such as tennis players, who put a lot of repetitive stress on their calves. Achilles tendonitis is also seen among those who have experienced rapid weight gain, those whose feet are flat or pronate excessively, and even those who wear poorly fitted shoes.achilles pain
     Symptoms of achilles tendonitis often begin with stiffness and creaking when getting out of bed in the morning, a mild ache in the back of the leg or above the heel after running or sporting activities. Light pinching of the sides of the achilles tendon will cause pain or soreness. Episodes of more severe pain may occur after prolonged running, stair climbing, or sprinting. Because achilles tendonitis symptoms are bound to worsen without treatment, it is paramount that you treat it early with a combination of working with your doctor, and learning self-maintenance strategies.
If you are experiencing persistent pain around the achilles tendon, contact your podiatrist. Dr. Chang and Dr. Murray at Blue Ridge Foot and Ankle Clinic are experienced and highly successful at treating achilles tendonitis.
     When you make an appointment with Blue Ridge Foot and Ankle to discuss your achilles tendon pain, be sure to think through what information will be crucial for your doctor to properly diagnose your achilles pain. Did your pain begin suddenly or gradually? When are your symptoms worst? What types of shoes do you wear regularly during the day, and what types of shoes do you wear for exercise? Have there been any dramatic changes in your lifestyle recently? Where exactly is the pain, and does any activity or movement trigger it? Does the pain lessen with rest? Have you tried any home remedies (such as Advil or Ibuprofen, ice, compression, or rest), and how has your achilles tendon felt in response? You doctor will consider this info, as well as conducting a physical exam of the area to identify pain, tenderness and swelling, as well as testing the raninflammed achillesge of motion, alignment and reflexes of your foot and ankle. If a tear is likely or suspected, your doctor will order an MRI to produce images of your achilles tendon.
     There are various measures your doctor and you can take to make your ankle repair and stop hurting, so you can get back to the activities that you love. Most cases of achilles tendonitis respond well to self-care: over-the-counter pain medications such as ibuprofen, rest, ice, compression, elevation, home exercises, even better fitting (more appropriately supportive) shoes. Your doctor may prescribe heel lifts, orthotic devices, physical therapy, and, if it does not heal over several months, possibly even surgery to repair tears in your tendon.
     To prevent injuries such as achilles tendonitis, remember to increase your activity level gradually. Cross-train and be sure to do exercises that specifically strengthen your legs and calves without putting undue stress on them. Stretch daily, after exercise. Keep your body hydrated and consume nutrient rich foods, which increase circulation and the rate of healing. Avoid smoking, which weakens tendons by reducing the rate of healing at a cellular level. Wear well-fitted shoes (with adequate cushioning for your heel and a firm arch support), which you can find in Charlottesville at Ragged Mountain Running or Richey and Co. Shoes . And, most importantly, rest (slow down or stop) when you start feeling the pain come back.
Dr. Chang and Dr. Murray to have decades of experience successfully treating achilles tendon injures. So contact us at Blue Ridge Foot and Ankle to help you solve your achilles pain.
 
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
 
 
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
 
 
 
 
 
 
 

Doc, why won’t my shin splints get better?

November 24th, 2010 by Dr.Chang

Compartment syndrome masked as shin pain, recalcitrant.I had a recent case that challenged my diagnostic skills. A young soccer athlete was referred to me who complained of right lower leg pain following the start of soccer practice approximately 6 weeks prior to presentation in my office. He had been initially diagnosed with “shin splints” and treated with R.I.C.E methods by his team trainer. His symptoms persisted and he was seen by his primary care doctor. The assessment was same. He was suffering from “severe” shin splints. Oral anti-inflammatory meds, R.I.C.E. and some home exercises were given. NO response then he was ordered outpatient physical therapy. A few treatments went by without relief; the patient’s primary care provider referred him to me.

My exam showed the patient demonstrated “classic” shin splint palpable tenderness along the distal medial and anterior lateral aspects of the right leg. The worsening of the pain with exercise was present, also a common finding in the shin splint injuries. With my athlete patients I will often make the patient exercise to the point of where they get similar onset of pains reported. We did so. He described pain that was both an ache and a burn in sensation at same locations above. He had strong pulses. All sensation was intact. This young man had very large, muscular calves which were very tight and turgid even in resting condition. His leg x-rays were negative for stress fracture. My next most likely diagnosis was Chronic Exertional Compartment Syndrome (CECS).  I set up a time to analyze leg compartmental pressures: resting and post exercise reading are indicated.  His were 10 mm and 38 mm respectively.

Shin splints have a variety of presentations.

This syndrome can encompass a number of overuse disorders, they all share a common finding of periostitis (bone inflammation) near the origins of the soleus and/or flexor digitorum longus muscles. Flexor origin shin splints tend to be distal medial in pain…. Soleus origin shin splints can be that but also deeper and lateral (seemingly – anterior pain in location) … This is the tricky presentation…. . Commonly, the patient demonstrates many contributing factors most notable being; structural pathology predisposes patients to excessive and unbalanced pronation during the run/gait cycle, with subsequent overuse of the muscles of the distal extremity.

The differential diagnosis for this condition includes: stress fracture, chronic or exertional compartment syndrome, sciatica, deep venous thrombosis, popliteal artery entrapment, muscle strain, tumor, and infection.

Digging deeper for some answers…

Exertional compartment syndrome is a condition in athletes that can occur from repetitive activities and progressive competitive training. The anterior compartment of the leg is the most commonly affected location. Patients describe pain also as is burning in nature, which worsens with activity and completely subsides after 15 minutes of activity cessation. It seems, initial activity places a demand for blood supply for the muscles. This results in vascular inflow, engorgement, and expansion of the muscles in a confined fascial structure or “compartment”. The result is relative compression and pain. Resting and immediate post exercise is the gold standard for the diagnosis of chronic exertional compartment syndrome. A dynamic, post-exercise reading of greater than of 35 mm Hg is highly indicative of compartment syndrome. A dynamic pressure greater than 40 mm Hg is considered diagnostic.

Conservative therapy may help in the near term, but the condition will often flare when athletics are resumed. When indicated, surgical decompression via fasciotomy of the involved compartment is definitive in correction of the problem.

What is to become of this young athlete?

Considering the failure of conservative care, and the indisputable pressures measured…. the patient elects undergo anterior leg compartment release. I expect this to fully solve his problem. For me, lessons are always learned.
On referral patients, which are a good bulk of our clinic’s sports medicine cases, I always seek a wide ranged differential diagnosis. It may walk like a duck, and talk like a duck, but some times geese can look and talk that way too. In this case, I applaud the referring provider who saw that this patient may benefit from a specialist’s point of view. I called her on my findings, diagnosis and course of care for the patient in question. I got the proverbial …. “Ah Hah..I knew it !” As it turns out here, the referring physician demonstrated more than adequate working knowledge of lower extremity. As doctors, we are not expected to know everything… but we need to be smart enough to know what we don’t know.

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