The posterior tibial tendon is located on the inside of your ankle and plays a major role in supporting and maintaining the arch on the bottom of the foot. Due to the high demands of the tendon with every day life, it can result in overuse of the tendon. This overuse is referred to as posterior tibial tendon dysfunction. When this occurs, patients will eventually develop a flat foot deformity and loss of arch height due to the weakened tendon no longer being able to support the arch. This condition is commonly seen in middle-aged women. Those with diabetes also have an increased risk.
The major problem with posterior tibial dysfunction is that it is a progressive disorder. This means that it will get worse overtime. The initial symptoms of the condition are pain and tendonitis; however there is normally no decrease in strength of the tendon or loss of arch at this stage. As it worsens, the tendon will develop tears and the patient will eventually end up with a decrease in the arch height and a flat foot. With early diagnosis, the progression can normally be slowed, or halted, through the use of orthotics, bracing, immobilization and physical therapy. If the dysfunction is left untreated, or progresses, then it may eventually have to be treated with surgical intervention.
–Dr. Colleen Law
- Posted in Common Foot Conditions, Diabetic Foot, Foot Doctor, Foot Pain, Foot Surgery, New Doctor, Podiatrist, Podiatry
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- Tags: Arch, charlottesville podiatrist, Diabetes, diabetic foot care, Posterior Tibial Tendonitis and Tendonosis
Colleen Law graduated from Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania and completed her residency at St. Luke’s University Health Network in Allentown, Pennsylvania. At St. Luke’s, she underwent extensive training in elective and reconstructive forefoot, rearfoot, and ankle surgery, as well as experience in wound care and diabetic limb salvage.
Prior to her medical education, Dr. Law attended Lehigh University, where she was a member of the cross country and track and field teams. Through this experience, she developed an interest in sports medicine, which led her to pursue a career in podiatry. In addition to her interest in sports medicine, she is also interested in elective and reconstructive foot and ankle surgery and diabetic limb salvage.
During her free time, Dr. Law enjoys spending time running and hiking with her husband Matt and vizsla.
Dr. Law is accepting new patients beginning July 17, 2017.
With July 4th around the corner we are spending more time outdoors. The pool, beaches, and even your own backyard can put your feet at risk of injury. Here are some reasons not to ditch your shoes this summer.
- Puncture Wounds / Trauma: Cuts, scrapes, and sharp objects like rusty nails or broken shells cause breaks in the skin and set you up for serious bacterial or viral infections.
- Skin Burns: Sidewalks, sand, and driveways can get very hot and burn the skin on the bottom of the foot. This is especially a risk for diabetic patients or patients with neuropathy who may not have the ability to feel warm temperatures or sharp sensations. Never walk or run on a hot surface without footwear.
- Infections: Pools, hot tubs, saunas and public showers can harbor bacteria, viruses, warts and fungus. Protect your feet with pool shoes or flip-flops. Have a fun and safe summer and remember to use appropriate footwear for your activities
Toe nail fungus cures can include both oral and topical medication treatments. The gold standard for treating onychomycosis in an otherwise healthy individual is the oral therapy. The most widely prescribed medication today is Terbinafine ( Lamisil – Novartis). Newer oral medications are currently in development and clinical testing. Oral antifungals, like Terbinafine, are very safe medications if properly used. Terbinafine tablets has adverse response rate of less than 3 percent. Typically, the dosing for Terbinafine is one tablet per day for three months. Blue Ridge Foot and Ankle Clinic will take blood test to verify normal liver function prior to starting this medication.
Dr. Murray and Dr Chang may also take a sampling of the nail and have it lab tested to confirm that it is true nail fungus. Visual inspection is adequate to make a diagnosis, but when uncertain or as required by insurance companies’ lab confirmation may be required. Sometimes a thickened nail is nothing more than hyper-keratinization of the underlying nailbed from repeated trauma. Nail thickening alone does not automatically make an Onychomycosis diagnosis. However, a thickening nail from thickened skin and repeated trauma makes is a good focal point for fungus to establish.
In addition to oral mediation, at the Blue Ridge Foot and Ankle Clinic we will also use topical antifungal medications to treat the infection from the outside. We also have very effective regimens of topical treatments which does help to reduce the fungal infection of the nails and help prevent this aggressive condition from getting worse. When attempting topical therapy, serial aggressive nail debridements by your podiatrist are recommended to enhance the outcome.
The best way to use topical medication is to see a foot specialist who will thin down and cut away as much of the diseased nail as possible (a painless procedure), so that the topical medication will penetrate to the live fungus more readily. The topical medications then are applied once to twice a day by the patient. The nail has to be maintained or kept thin on a regular basis. Depending on the degree of fungus this process can take upwards of a year for new healthier nail to grow out. We have seen some very gratifying results with the combination of oral and topical medication.
Laser treatment of toenail fungus is becoming more common. Laser treatment is indicated and recognized by FDA for temporary clearing of toenail fungus. It is not a covered by nearly all medical insurance companies and can be very expensive. The doctors at Blue Ridge Foot and Ankle Clinic do not advocate this form of treatment for toenail fungus.
As with any medial condition, there sometimes there can be unsuccessful results using either topical or oral medication but it is important to follow all of the directions for the best results possible. The outcome will often be dictated by the severity of the condition upon initiation of treatment. Returning toenails to a perfect pristine state is nearly impossible. Making toenails less ugly, less discolored, less thick and fungus free is an obtainable goal.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.
Plantar Fasciitis: Treatment Pearls
by Douglas Richie, Jr. D.P.M., President Elect AAPSM (2003 – 2004)
Epidemic Of Heel Pain:
Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age segment in our population.
The orthopedic and podiatric literature have been filled with original scientific investigations and anecdotal reports about the appropriate surgical and non-surgical approach to plantar fascitis. The vast majority of these scientific articles deal with the general patient population presenting with heel pain. There is a growing consensus of opinion that plantar fascitis is best treated non-surgically with the vast majority of patients becoming asymptomatic within twelve months of the onset of symptoms.
While patience, rest and tolerance of pain are virtues recommended to the patient presenting with plantar fascitis, different treatment strategies must be employed when dealing with the athlete.This article will focus on the differences in treating plantar fascitis in athletes vs. the general, sedentary population.
Subcalcaneal pain syndrome in athletes is thought to be brought on by an overload of the plantar fascia.However, the mechanism of this overload is debated.Overload causes micro-tears at the fascia-bone interface of the calcaneus or within the substance of the plantar fascia alone.The central band of the plantar fascia is primarily affected where a hypercellular, inflammatory response occurs within the fibers of the fascia, leading to degenerative changes.
A spur may result from further inflammation but is not implicated as the primary source of heel pain.Many studies have shown the presence of spurs on the heels of asymptomatic patients.One study found that only 10% of all calcaneal spurs visible on x-ray were actually symptomatic.
Other authors have attributed “painful heel syndrome” to an entrapment of either the medial calcaneal nerve or the first branch of the lateral plantar nerve.However, the mechanism of entrapment proposed by these authors is still related to overload of the soft tissue and fascial structures on the plantar and medial aspect of the calcaneus.
Although heel pain is common, there is no commonality of opinion of the biomechanical etiology of this syndrome.Contributing factors reported in the literature include leg length inequality, pronation of the subtalar joint, restricted ankle joint dorsiflexion, weakness of plantar flexion, high arched feet, low arched feet and heel strike shock.Studies have shown that decreased arch height has shown no correlation to the development of plantar fascitis in runners.In fact, it is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot.
Scherer and coworkers have given the best insight into the pathomechanics of plantar fascitis.Their study proposed that supination around the longitudinal axis of the midtarsal joint is a common feature in over 100 feet presenting with heel pain.Supination about the longitudinal axis of the midtarsal joint can occur in two primary situations:when the heel everts past perpendicular (heel valgus) or when a forefoot valgus deformity is present (sometimes accompanied by rearfoot varus).
TREATMENT STRATEGIES FOR THE ATHLETE
In most cases, the goal of the athlete is to quickly return to activities to minimize loss of fitness and performance.This will put pressure on the treating practitioner to be more aggressive than treating cases of more sedentary patients.
A survey was conducted by this author of the board members of the American Academy of Podiatric Sports Medicine two years ago to compare treatment protocols for athletes vs. standard population.The following treatment pearls were elicited:
1) Assignment to alternative activity
The athlete must be encouraged to maintain cardiovascular fitness during rest from damaging activities that may delay healing.For the runner, dancer or volleyball player, this means a complete cessation from running and jumping activities until acute symptoms subside.On the other hand, the athlete should be assigned to alternative cardiovascular fitness activities that minimize impact and loading on the plantar fascia including stationary cycling, swimming, upper body weight machines, and low resistance flat-footed stair master machines.
2) Change and modulation of footwear
Footwear analysis is critical for evaluating athletes with subcalcaneal pain.The footwear may be a contributory factor and can be utilized as a powerful treatment modality.Athletesshould be placed into shoes that have a minimal 1″ heel height with a strong stable midfoot shank and relative uninhibited forefoot flexibility.The American Academy of Podiatric Sports Medicine has a list of recommended footwear for the athlete that can be obtained on their web site:www.aapsm.org.It is well recognized that recent trends in athletic footwear have actually predisposed to greater frequency of plantar fascitis due to the fact that athletic shoes have weaker midsoles with newer designs.The popular “two-piece” outsoles with an exposed midsole cause a hinge effect across the midfoot placing excessive strain on the plantar fascia in the running and jumping athlete.These shoes must be eliminated if the injured athlete is wearing them.Careful attention must be paid to having the athlete keep shoes on in the house and during all standing and walking activities.Barefoot and sandal-wearing activities are prohibited.
3) Home therapy
Athletes are accustomed to designing and participating in their own training programs.They are willing participants in their own treatment programs. Heel cord stretching is central to the rehabilitation process to decrease load on the plantar fascia and encourage healing.The use of plantar fascia night splints has been well proven to be a treatment adjunct for plantar fascitis by placing the heel cord and the plantar fascia on a sustained static stretch during sleeping hours while preventing the normal contractures that occur in the relaxed foot position during sleep.Having the athlete roll or massage their foot on a golf ball or tennis ball is helpful to improve blood flow and break down adhesions in the injury site.
4) Custom foot orthoses
Intervention with semi-rigid custom foot orthoses has been well proven in many prospective and retrospective studies showing successful outcomes in patients with plantar fascitis.In the athlete, the use of foot orthoses should be considered earlier than in the average sedentary patient because of the fact that the athlete will be subjecting their feet to greater stresses during treatment and certainly after return to activity.Athletic footwear is more amenable to semi-rigid and rigid orthotic therapy than are casual shoes worn by sedentary patients.Sports podiatrists are more likely to employ arch taping procedures as a precursor to or adjunct to orthotic therapy.Athletes respond very favorably to the immediate intervention and relief obtained by expertly applied arch taping procedures.
5) Physical therapy
Athletes are amenable to referral for physical therapy because they are willing to invest the extra time to expedite recovery.Many athletes are used to going to the training room for hands on rehabilitation.Athletes appreciate a partnership between the sports podiatrist and the physical rehabilitation specialist.
6) Anti-inflammatory medication
Sports podiatrists should be cautioned against over-aggressive use of anti-inflammatories in treating the athlete.While it is tempting to utilize corticosteroid injections to expedite healing, athletes are often skeptical of receiving this treatment and are certainly at greater risk for sequela of over-ambitious use of steroid injections.There are reports in the literature of athletes undergoing spontaneous rupture of the plantar fascia after even single injections of their plantar fascia with corticosteroid.The conservative, biomechanical interventions outlined above should be implemented before considering injection therapy.
Athletes presenting with plantar fascitis must be treated aggressively because they have immediate needs and long-range goals that are different than those seen in the average sedentary patient with heel pain.It is important to be aggressive and employ a variety of modalities and treatments when formulating a treatment plan for the athlete.At the same time, caution should be made about the overzealous use of quick fixes, including corticosteroid injections because of the potential deleterious effect on athlete.
The cornerstone of plantar fascitis treatment for the athlete is biomechanical.Podiatric practitioners possess the greatest skill set and knowledge available in medicine today to adequately address the pathomechanics of plantar fascia overload.The use of properly casted and designed custom foot orthoses should be the cornerstone of non-surgical treatment of subcalcaneal pain in the athlete.
Resistant Plantar Fasciitis Treatment Program (Initial)
Contributed by Richard Bouche D.P.M. , William Olson, D.P.M., Stephen Pribut, D.P.M., Douglas Richie, Jr,. D.P.M.
PHASE 1- Acute Phase:
- Goal decrease acute pain and inflammation:
- absolute or relative rest- Decrease sports activity to avoid rebound pain
- ICE: 2 appliations of 20 minutes per day
PHASE 2- Rehabilitation Phase:
- Further decrease pain and inflammation:
- contrast baths
- Maintain/increase flexibility of injured (and surrounding) tissue:
- gentle stretching exercises: calf, hamstring, posterior muscle groups
PHASE 3- Functional Phase:
- Functionally strengthen intrinsic muscles of the foot
- closed chain therapeutic exercise
- Doming of Arch (towel toe curl)
- closed chain therapeutic exercise
- Protect injured area during functional activity
- stability running or other appropriate athletic shoes
- orthoses as needed
Note: this is probably the most important phase because it prepares the patient for their return to activity. Care needs to be taken at this stage not to allow the patient to overdo these exercises and stay within their limits as re-injury can easily occur.
PHASE 4- Return To Activity
Return to desired sport activity: gradual, systematic, “to tolerance”
Initiate preventive strategies:
appropriate athletic shoewear
functional exercises (i.e., pilates, plyometrics)
revise training program
Note: Be careful in the first months return to exercise to avoid recurrence of pain.
Consider shock wave therapy if there is a 6 month failure and a failure after repeated modification and remaking of orthotics.
- Posted in Athletic Injury, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, EPAT, Extracorpeal Pulse Activation Treatment, Foot Doctor, Foot Pain, Heel Pain, Orthotics, Plantar Fasciitis, Podiatrist, Podiatry, Running, Shockwave Therapy, Shoes, Shoes and Socks, Uncategorized
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- Tags: Athletics, charlottesville podiatrist, Custom Orthotics, Exercise Related Pain, foot inflammation, Overuse Injury, Plantar Fasciitis, Sports Related Injuries
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.
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.
Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.
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.
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.
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.
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.
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.
- Posted in Achilles Tendon, Athletic Injury, Blisters, Bunions, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, EPAT, Foot Doctor, Foot Pain, Heel Pain, Ingrown Toenails, Leg pain, Neuroma, Orthotics, Our Community, Plantar Fasciitis, Podiatrist, Podiatry, Shockwave Therapy, Shoes, Shoes and Socks, Triathlons
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- Tags: Athletics, charlottesville cycling, charlottesville podiatrist, Custom Orthotics, Exercise Related Pain, foot inflammation, foot surgery, mortons neuroma, Overuse Injury, Plantar Fasciitis, Sports Related Injuries, Tendonitis
Blue Ridge Foot and Ankle Clinic enjoys promoting physical activity in our community. We believe physical exercise is the best medicine available. Charlottesville and the Shenandoah Valley are fantastic areas to enjoy the outdoors. Our clinic sponsors the 2013 Virginia Off-Road Series mountain bike races and some of the Devils Playground fun runs at Devils Backbone Brewery in Roseland, VA. We want to encourage you to find local events this summer to participate in. Your participation is a healthy choice and helps promote physical activity to others by being a role model.
Our staff participates in many physical activities year round. Dr. Murray and Dr. Chang enjoy activities such as cycling, hiking, skiing, and ice hockey. Kindra Jones, medical assistant, hits the gym regularly. She’s expecting an addition to her family this fall and now exercising for two. Congratulations Kindra! Mary Mead, billing specialist, and her husband walk all over the streets and trails of Charlottesville. Our jack of all trades, Amy Flevarakis, participates with her family in events such as the March of Dimes Walk. Newbie, Teresa Thompson, enjoys hiking and running the trails in and around Staunton and wants to run her first 5k race this year. Welcome to our practice Teresa. Mallory Snow, Charlottesville receptionist, stays fit by running while her kid participates in dance class. Mallory and Amy are running the Color Me Rad 5K in Virginia Beach this fall. Mark Smith, Waynesboro receptionist, rides his bike daily and competes in local mountain bike and running races. Aside from keeping our offices running smoothly, Mary Ishee – office manager, walks with her daughter and has participated in the Charlottesville Women’s Four Miler for the last two years.
We hope you join us this summer in some of the fun activities and events our communities have to offer. Let us know if there is anything we can do for your feet or ankles to help you be a role model to you family and friends.
Here are some sites to help you find local activities:
Bike rides and racing:
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.
- Posted in Athletic Injury, Children, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, Our Community, Our Team, Podiatrist, Podiatry, Running, Seasonal Foot Care, Uncategorized
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- Tags: Augusta Health, charlottesville cycling, charlottesville podiatrist, charlottesville shoe stores, Custom Orthotics, Exercise Related Pain, mark lorenzoni, mortons neuroma, Overuse Injury, Plantar Fasciitis, running shoes charlottesville va, Sports Related Injuries, Winter Foot Care, Winter Running
A neuroma is a growth or thickening in the nerve tissue due to compression or irritation of the nerve. While neuromas can develop in different parts of the body, they are most commonly found in the feet between the third and fourth metatarsal toes and called Morton’s Neuroma, or intermetatarsal neuromas. Populations who wear restrictive shoes, or have foot abnormalities such as bunions, hammertoes, flat feet, or more flexible feet, are at a higher risk of developing this type of nerve damage. If you suffer from Morton’s neuroma, you probably already know this by the instant relief from the burning and aching toe pain once you take off your shoes. That’s because the width of your shoes often aggravate an already irritated nerve.
Neuromas have a variety of symptoms that vary from pain to tingling, burning or numbness, and even feeling as if something is inside the ball of the foot. Symptoms often have a gradual onset, first only flaming up when wearing shoes with a tight toe box or while engaging in activities that stress the ball of the foot. Initially, symptoms can be relieved by removing a constricting shoe, massaging the tender area, and by avoiding aggravating activities. However, as time passes, symptoms will get progressively worse. If untreated, neuromas can lead to permanent nerve damage, so consult your podiatrist early about your neuroma.
Treatment and prevention vary. First thing first, make sure you have the proper shoes for your feet! Your podiatrist will first suggest using shoe inserts or special padding techniques to relieve the pressure from the affected area. Additionally, icing, using over the counter or custom made orthotics, modifying activities that aggravate the injury, taking NSAIDs, or even cortisone and local anesthetic injections can help. In more severe cases, surgery will be a viable option to remove the neuroma altogether.
Shin splints, also called tibial stress syndrome, are a common complaint of runners who increase their mileage or intensity too quickly. Feeling throbbing or aching in the shins is surprisingly common for athletes and runners. Shin splints, however, aren’t a single medical condition. They can be caused by a number of factors; irritated and swollen muscles, over use, stress fractures, over-pronation or flat feet, and running on hard surfaces, to name a few. With shin splints you will feel a dull and aching pain in the front of the lower leg during exercise, or even after exercise. Shins may be painful to the touch, muscles can swell, and nerves can even be affected causing parts of the feet to go numb.
There are various places where the shin can cause pain. Usually, a flatfoot can cause pain in the tibialis posterior, or the front and outside of your shin. High arches can cause anterior lateral shin splints, on the inside of your shin. Less common is pain deep in the back of the leg, caused by tightness in your inner calf muscles, the soleal complex. No matter what kind, shin splints are a mechanical issue, caused by excessive mileage and a pounding stride.
There is good news for all of you who suffer from shin splints: they are very treatable, with quite high success rates! So have hope as you begin your treatment plan. Treatment for shin splints varies according to the nature of your own individual injury. In general, the very first thing to do is to rest in order for your injury to heal. Additionally, ice, NSAIDs, arch supports, range of motion exercises (as recommended by your podiatrist or physical therapist), a neoprene sleeve to support and warm the leg, and physical therapy will be recommended. If your shin splints are caused by stress fractures, you may be put in a walking boot or even need surgery for severe cases.
Remember that recovering from shin splints can be a frustratingly long process. Many runners need up to six months, or more, to recover. Resist the urge to start running again before you are ready, because your injury could become more severe. To bide time and to stay in shape until you heal, you can take up activities that have little impact on your legs such as swimming or cycling. You will know when you are ready to run again by a number of factors including equal flexibility in your legs, activity does not cause pain, or when x-rays show that your stress fractures have healed. To avoid shin splints wear good shoes with the right amount of support for your foot, warm up and then stretch before working out, run on soft surfaces, and stop working out when you feel pain in your shins.
The posterior tibial tendon attaches the tibialis posterior, a muscle deep in the back of the lower leg, to the metatarsal bones. As one of the major supporting structures of the foot, we could not walk without the tibialis posterior. It goes figure that the onset of posterior tibial tendonitis can be painful and impair walking, running, and other activities.
Posterior tibial tendonitis and tendonosis occur when the tendon undergoes stress, inflames or gets small tears in it, which, in turn, impairs the tendon’s ability to support the arch of the foot. Most commonly this is a result of overuse and inconsistent activity after already having the tendency to pronate excessively or a preexisting flatfoot. Once the posterior tibial tendon tears, PTTD is also referred to as “adult acquired flatfoot,” as the condition usually occurs in adulthood. Posterior tibial tendonitis and tendonosis is a progressive disorder, so catch symptoms early by consulting your local Charlottesville or Waynesboro podiatrist. If you feel pain along the course of the tendon or on the inside of the foot and ankle, notice swelling, redness, a warm sensation, a flattening of the arch or inward rolling (pronation) of the ankle consult your podiatrist for a diagnosis or treatment. In more advanced stages, the arch will begin to flatten, changing the dynamic of the foot and your stride as you walk or run. Your toes will turn outward while your ankle rolls inward, pain will shift to the outside of the ankle, and the injured foot, even the ankle, may develop arthritis.
For advanced cases, surgery will be required. However, early treatment will include NSAIDs, icing, shoe modifications, bracing or orthotic devices, immobilization by a short-leg cast or brace that allows the tendon to heal, and avoiding weight-bearing activities for some time. Physical therapy exercises and treatment will include ultrasound therapy and exercises to strengthen and increase the flexibility in the tendon and attached muscles.