Tunnel syndrome in the leg. Shin splint syndrome: treatment, causes, symptoms Shin splint syndrome treatment

Let's consider each of them in order.

Shin splints syndrome usually occurs in the early period of training in beginners and athletes when running fast and for a long time on a hard surface. The pain occurs locally in the middle part of the tibia in the range of 10-15 cm.

Shin splint syndrome (periostitis of the medial edge of the tibia), called inflammatory changes in the periosteum, is often associated with the separation of the bone shell from the bone itself. Hence the pain occurs in the front part of the tibia and in the back part. It all depends on which muscle and in what place “tears” the periosteum from the bone.

Actually, two types arise from this: posterior tibial and anterior tibial pain syndrome. The tibialis posterior muscle is responsible for preventing the lower leg and foot from overpronating. The tibialis posterior muscle and its tendon can become “overworked” if excessive pronation occurs in the forefoot. A similar problem arises when running intense physical activity.

An “overloaded” tibialis muscle becomes tense. Her tendon is stretched greatly to keep from tearing. Because the tendon is more firmly attached to muscle than to bone, the posterior tibial tendon pulls on the tibia. The periosteum is torn away from the bone, and painful periostitis – “shin splints” – develops. If this is not treated and you continue to exercise, the tendon will rupture and your foot will become flat. And then there’s surgery, so it’s better not to let it get to that point.

Anterior tibial syndrome is also called interfascial space syndrome. There are many muscles in the front of the lower leg (attached to the thumb and other phalanges, the medial part of the foot), and when some muscles become inflamed and swollen, the pressure on other muscles increases, since the space between the fasciae is limited. This causes a decrease in blood flow, and accordingly some discomfort and pain.

What are the causes of shin splints?

1) Strong impacts from landing on the heel when running.

2) Excessive rotational forces (rotations) in the foot and ankle joint.

3) Overloaded calf muscles.

4) Pronation of the foot, flat feet, high arches.

5) Inappropriate, worn-out shoes.

6) Short, insufficient warm-up and cool-down.

The mainstay of treatment is cessation of exercise, rest, cooling, soothing ointments, and, if necessary, NSAID tablets (non-steroidal anti-inflammatory drugs).

Preventing shin splints:

1) Good warm-up and cool-down.

2) Myofascial massage.

3) Stretching the lower leg muscles.

4) Bathhouse, swimming pool.

5) Special shoes with reinforced heels and soles.

6) Gradual increase in loads, no more than 10% of kilometers per week.

7) Compression gaiters or taping.

8) Cross-country running, change of load, for example, basketball, football.

Common runner injuries:

Previously, sports medicine was limited to treating injuries suffered by professionals or elite athletes. They were most often treated by orthopedic surgeons because the bones and joints suffer the most in contact sports and other types of physical activity. If a non-competing athlete complained of an injury, he was recommended to see a family doctor, who prescribed rest, painkillers, and prolonged abstinence from physical activity. Fortunately, this is no longer the case. In all developed countries, millions of adults engage in one form of sport or another every day. Thus, there has been an urgent need to expand the field of sports medicine to provide care to recreational athletes, who are as susceptible to injury as professionals.

Many of us associate the start of the fitness craze with running or jogging. In 1984, the profits of one of the major sneaker manufacturers were about a billion dollars. Now the income of sports shoe manufacturers is hundreds of times higher.

Since my previous book, many other sports have gained popularity. And now it is not tennis, squash or badminton fans who most often turn to the doctor, but runners. Running has regained its dominance, and runners account for the largest percentage of patients. They are followed by a group of those who prefer aerobic types of physical activity: cycling, aerobics, machines simulating skiing and skating, treadmills (for walking and running), running up stairs, etc. About other popular sports that attract both athletes - professionals and amateurs - and spectators, I will tell you in Chapter 12.

The reasons for their popularity vary, but not the least of them is the desire for good physical shape. Some people sign up for health groups to expand their social circle; others are drawn to team sports where the competitive spirit can be satisfied. But running is a completely different matter. Runners are often completely reluctant to combine exercise with socializing. They enjoy being one with nature, and often the so-called “runner's drug” produced by their own body, endorphin. Obviously, the more you exercise, the more endorphins are produced, the less pain and discomfort you feel, the greater the euphoria.

So what does this have to do with legs? It’s just that runners, tennis players, and aerobics enthusiasts often exercise without noticing the pain threshold. And when this happens, they trigger a sports injury. Pain is a signal from the body that something is wrong and that you need to stop and take a break. People often don't perceive this signal until they finish the activity. Only then do they see a doctor. And sometimes it turns out that the moment when it was easy to cope with the disease has been missed.

Sports medicine specialists most often encounter complaints of leg problems resulting from overuse. Approximately 25% of patients have knee pain, the same number suffer from foot diseases, about 20% of calls are related to the hips and lower back. Another 20% falls on the neck, shoulders, and elbows. This is mainly the result of overload when swimming, lifting weights, or working with other equipment. People who do intensive aerobics tend to have problems with their shin bones. Now there are fewer such injuries, because step aerobics and its less aggressive varieties have appeared.

Many knee, leg and foot conditions are directly attributed to poor lower extremity biomechanics. The same can be said about complaints of pain in the hips and lower back. This gives me full time employment. And it is very pleasant to see how much higher the quality of life of my patients becomes thanks to the correction of biomechanical errors with the help of orthopedics.

I want to emphasize that most of what I will tell you about runners also applies to lovers of the treadmill and intense walking. I treat them for metatarsal head pain, neuromas, plantar fasciitis, and tibia dysfunction. The issue is not the speed of walking, but the distance, duration, type of shoes and, of course, biomechanics.

An avid runner who cannot do what he loves because of an injury is a very sad sight. And all kinds of diseases lie in wait for him - from problems with nails to pain in the spine. The list is so long that it would be more reasonable to divide the diseases into groups corresponding to the parts of the spine that they affect.

Athletes who run long distances, whether in one day or several, eventually develop blackened nails. This color comes from the blood clotted underneath them. The longer you run, the more your feet swell due to the high temperature inside the shoes. After a while, the shoe becomes too tight and comes into contact with the forefoot and therefore the nails with every step.

This friction damages the nail and nail bed. The nail rubs against shoes and the nail bed, causing blisters and pinpoint bleeding. The blisters burst, the liquid and clotted blood in them dry up, and the skin of the damaged area sticks to the nail. The end result is damage to the cells from which the nail grows. As a result, the nail begins to grow abnormally.

If the nail matrix is ​​severely damaged, the runner will grow deformed, oddly colored nails that will never return to normal.

Obviously, this “mark of courage” can be avoided. You can simply give up running long distances or buy only the best running shoes. It's a good idea, although not very practical, to have a spare pair of larger shoes when running a marathon. Perhaps some genius will invent sneakers that automatically expand as your feet become swollen.

A side effect of the “black mark of courage” is a fungal infection, for the development of which ideal conditions are created. If your nails become discolored, it is best to start using an antifungal medication right away. An untreated nail may eventually fall off. This is not so scary, especially since over time it will grow, although it will be shapeless. This problem is rather aesthetic; it does not cause inconvenience, does not affect the functioning of the foot and is unlikely to keep you from running many kilometers every day.

Athletes constantly develop blisters (water calluses) on parts of the body that are subject to friction.

With their help, nature tries to protect the deep layers of the skin (dermis) from inflammation. A fluid-filled sac appears between the dermis and epidermis, preventing friction from spreading to the deeper layers. But everyone knows that the blisters themselves are very painful, especially if the source of irritation is not eliminated.

Runners don't just get blisters under their fingernails. They most often occur under the first metatarsal head and at the ends of the toes. It is in these places that the foot experiences friction when overloading and wearing inappropriate shoes.

Blisters are easy to recognize and easy to treat. First of all, the source of friction must be eliminated. This means replacing shoes. If blisters continue to appear, I would recommend inexpensive insoles that support the arch of the foot and prevent it from slipping forward. Another option for protecting your feet is to apply moisturizer under a protective bandage. The scheme is simple: the thicker the bandage, the less pressure.

If you continue to run with water calluses on your feet, calluses gradually form in their place, protecting the deeper layers of the skin. This is another example of nature at work. Of course, you will encounter a new problem, but there will be no more calluses in these places.

A ruptured blister can become infected. It must be treated with an antiseptic and covered with a bandage/plaster/napkin. To relieve pressure, the painful blister can be punctured with a sterile instrument. But after this, it is necessary to prevent infection from entering the wound.

Runners rarely develop water blisters on their heels. They are the result of bad shoes and very long distances. But speed skaters and figure skaters often suffer from them on their heels and ankles if their boots do not fit them.

Runners constantly place stress on the forefoot and are therefore susceptible to injury.

If you remember in Chapter 4, I called the forefoot a workhorse because it is in contact with the ground 75% of the time during the gait cycle. So it makes sense that runners, who land heavier than normal walkers, put much more stress on their feet than the average person.

So, injuries such as marching fractures of the metatarsal heads are not uncommon for runners, especially after long-distance races; neuromas and other diseases caused by nerve compression; capsulitis or synovitis of the metatarsophalangeal joint; inflammation of the sesamoid bones or their fracture.

As I noted in Chapter 4, marching metatarsal fractures occur in runners who overload their legs. They run for too long, too long, in the wrong shoes. While running, the athlete may hear a characteristic sound, but will not feel pain or notice swelling. This will happen in a few hours. Then the pain will become quite noticeable.

I already discussed the symptoms and treatment of marching metatarsal fractures in Chapter 4, but I would like to add something to prevent runners from making their situation worse. Under normal circumstances, such fractures heal on their own. And abnormal circumstances are attempts to run with an unhealed injury. The usual healing time for a fracture is 4 to 6 weeks. For older people, this period can last up to six months.

If you continue to run with an unhealed fracture, your recovery will be delayed and your pain will get worse rather than go away. There is also a high probability that when the bone heals, you will find yourself the happy owner of a deviation from the norm, which will remind you of itself over time. So don't pretend to be a hero. If you have a broken metatarsal, grit your teeth and stop running until you are completely healed. Your doctor will tell you when you can resume exercising and suggest other forms of physical activity to help you stay fit.

Many horses end up at the slaughterhouse due to fractured sesamoid bones, but fortunately this approach does not apply to people. However, as you learned in Chapter 4, a broken sesamoid bone is a nuisance and sometimes has to be surgically removed.

If surgery is necessary, it can be performed on an outpatient basis. After which the runner will be able to start training in 3-5 weeks. The same period is needed for a broken bone to heal without surgery. It is important for runners to remember not to train during the recovery period. You need to be patient because the sesamoid bone rarely heals completely. There is no need to despair here: a fracture often shows almost nothing after the inflammation has passed. The bone is now in two parts, but does not cause problems - in most cases. In all my years of practice, I have only once encountered a completely fused sesamoid bone. Surgical intervention in such a case is the exception rather than the rule.

I talked about chronic sesamoiditis in Chapter 4. Often it is not the fracture that is more difficult to diagnose, but the inflammation. It is also difficult to begin active treatment, since the constant load, inevitable when walking, falls on the already inflamed area. However, chronic discomfort and swelling can be reduced with ultrasound, ice and, if so advised by your doctor, two cortisone injections 2 weeks apart. But even with all these efforts, the cure rate does not exceed 50. For acute inflammation, non-steroidal anti-inflammatory drugs in tablets and injections help. If this does not solve the problem, you can remove some of the load from the foot with orthopedic means. Most likely, the inflammation will not go away immediately, and the runner will have to replace running for several weeks with other types of physical activity that are not so heavy on the forefoot. Women will also have to give up high-heeled shoes for a while.

Neuromas and other types of nerve compression are not uncommon among runners, figure skaters, speed skaters and cyclists. Unlike amateurs, professional runners get neuromas as a result of injury, and not as a result of prolonged overload.

Because the pain is concentrated at the metatarsal head, it is often mistaken for capsulitis or synovitis of the metatarsophalangeal joint. However, these diseases are more often caused not by running, but by other sports. If you recall Chapter 4, inflammation of the joint can lead to pinching of the nerve that runs between the toes along the affected area of ​​​​the foot. Therefore, it is quite possible to suffer from neuroma and synovitis or capsulitis at the same time.

One of the main causes of forefoot neuromas in runners is running on uneven surfaces for long periods of time. For example, if you run 10 km a day on an uneven surface for a week, you put a huge additional load on the heads of the metatarsal bones, because you create artificial excessive pronation of the foot. In most cities, roads are curved slightly to allow water to flow off them into drains. When running, the leg closest to the curb is positioned several degrees lower than the other leg. Artificially created pronation additionally loads the “lower” leg. If you already have mild overpronation, running on city streets increases your risk of injury.

Excessive pressure on the metatarsal heads can lead to pinched nerves in the forefoot, especially between the metatarsal bones. And this is a direct path to the development of neuroma. You can reduce the risk by choosing exclusively flat surfaces for running.

Another potential cause of neuroma is running shoes that are too tight. They may feel tight to begin with, or become so during a run as your feet become swollen. It is clear that tight running shoes cause the metatarsal bones to move, compressing the nerves running between them. The best thing to do in this situation is to choose your athletic shoes carefully and not lace them too tightly. If you already have a neuroma, it is better to stop running as soon as you feel that your feet feel cramped in your sneakers.

If the neuroma continues to bother you despite choosing the right routes and running shoes, you can try temporary padding and bandaging the painful area to separate it from the metatarsals.

Orthopedic inlays can be used as a long-term preventive measure. If there is severe inflammation at the site of the neuroma, anti-inflammatory drugs and cortisone (injected near the joint) are recommended. Surgery is performed only as a last resort.

Runners, skaters and figure skaters develop calluses, calluses and crooked fingers for the same reason as those who do not engage in sports: poor biomechanics of the feet and lower extremities. Calluses form on the soles of the feet - especially under the toes - to protect sensitive areas from the friction that usually causes blisters.

Consequently, their treatment is the same for everyone. The biomechanical error must be corrected. Runners can achieve this by simply changing their running shoes, as almost all modern models feature arch support. However, orthopedics may also be needed. Of course, you shouldn't give up your hobby because of a callus, callus, or deformed finger. The right shoes will help you control and, over time, solve the problem. Your hammertoe may need to be corrected through surgery. But if the operation is done well, within a few weeks you will be able to return to your normal running load.

In this book I have devoted very little space to the midfoot. The explanation here is simple - troubles rarely occur with its constituent elements. But runners and other athletes can injure this area, especially the tendons that attach to the bones of the midfoot.

Tendonitis (inflammation of the tendons) develops in runners with biomechanical problems that lead to uneven weight distribution across the foot and excessive muscle strain. As you learned in previous chapters, muscles are attached to bones by tendons. Tendons that are too tight are pulled and even torn from the bones.

Rupture or fraying of the tendons—and resulting periostitis—results in severe, painful inflammation that requires long-term treatment.

The four main muscles that keep the foot from pronating are the tibialis posterior, tibialis anterior, extensor hallucis longus, and extensor hallucis longus. If a person does not run, 3 degrees of pronation does not pose any problem for him. But when running at a good pace, additional stress is placed on the foot, and pronation even in the 4th becomes excessive, forcing these four muscles to stretch to the limit. As a result, the tendons at the ends of the muscles are on the verge of stretching or tearing. This situation provokes inflammation at the site where the tendons attach to the bones of the foot.

The tendon sheath usually has a poor blood supply, so inflamed and torn tendons heal slowly. Therefore, it is not uncommon for a runner with tendonitis to be advised by a family doctor to stop running altogether and allow the injury to fully heal. If you are given this advice, contact your sports doctor and listen to his opinion.

Precisely because tendonitis is difficult to treat, it must be nipped in the bud. Although it is most often caused by poor biomechanics and overuse syndrome, warming up and stretching before starting running should not be neglected.

Of course, you can do all the necessary exercises and still get tendonitis due to biomechanical problems that were not present before the exercise. Therefore, at the slightest hint of pain while running, stop running and seek advice from a podiatrist or sports medicine specialist.

If tendonitis is identified and the cause is biomechanical, the next step is to add orthotics to the shoe to compensate for the deficiency (usually poor pronation). If tendonitis is severe, you may have to stop running until the inflammation goes away.

Anti-inflammatory medications, ice, and/or ultrasound may help. When the tendon is almost healed, it is a good idea to begin doing a series of stretching exercises to ensure that the muscles and tendons in your foot are in the best possible condition when you return to running. I think that the physiotherapist will recommend a suitable complex for you.

The tendons of other foot muscles can also become inflamed due to friction if the foot is out of sync. In the midfoot, the extensor hallucis longus and brevis, flexor hallucis longus and brevis, and flexor toes longus and brevis may be injured. They also become inflamed due to biomechanical reasons or external factors - unsuitable sneakers or uneven surfaces. As in all other cases of tendonitis, inflammation of the tendons of these six muscles is recognized by pain in this area. Because tendonitis is difficult to treat, prevention is the best possible approach.

Today, tendonitis is often referred to as a repetitive stress injury. It is typical of those who perform the same action over and over again - computer operators, assembly line workers, musicians, representatives of certain sports. Muscle dysfunction naturally affects the tendons, putting them under strain and causing inflammation. When one muscle group stops working correctly, neighboring muscles take over its function. Over time, they too become tired and inflamed, and the pain becomes more widespread. If you find out which specific muscles and muscle groups are working incorrectly, you can prepare a therapeutic program for their rehabilitation.

In Chapter 7, we already discussed the causes and treatments for plantar fasciitis. This is one of the most common and least understood foot problems. As you may recall, these are often mistaken for heel spurs, which actually form to relieve pain rather than cause it. The plantar fascia attaches to the heel bone and the five metatarsal bones of the forefoot (see Fig. 7.2).

The main function of these ligaments is to support the longitudinal arch of the foot and control overpronation.

Plantar fasciitis is common in athletes, especially in sports where they have to constantly move from side to side, such as tennis or squash players. Repeated, sharp lateral movements create a huge torsional load on the entire foot. But plantar fasciitis is increasingly spreading among the general population thanks to more active lifestyles and uncomfortable shoes. In fact, this is largely an overload syndrome.

The hallmark symptom of plantar fasciitis is sharp pain in the medial and inner back of the heel, especially after sleeping or sitting for long periods of time. The skin color does not change, the heel does not swell. Severe pain may also occur after physical activity, such as running or playing tennis. If the disease is not treated, the pain will intensify and become almost constant, and will be felt even when walking.

If plantar fasciitis has reached an acute form, all physical activity must be avoided due to unbearable pain. More aggressive treatment with anti-inflammatory drugs and/or laser therapy (but not surgery) may be needed. Cortisone injections into the heel or surgery are a last resort. In parallel with aggressive treatment, it is necessary to correct the biomechanics, which have become the main culprit of the problem. Therefore, patients with plantar fasciitis should wear appropriate shoes and use orthotic inserts. Then their condition will not worsen, and the disease will not worsen. Sports enthusiasts should not resume activities until complete recovery.

Treatment time for plantar fasciitis depends on its severity. In mild cases, the patient will stop feeling symptoms after a few weeks, provided they wear good shoes and orthopedic inserts. If the inflammation is acute and advanced, recovery takes up to three months, in severe cases even longer.

In the vast majority of cases, with proper treatment, the periosteum grows back to the bone, and complete recovery occurs, although slight discomfort may persist in the morning for some time. But it will disappear over time, and fasciitis will not return if you help your foot with the right shoes and orthopedic devices.

Although ankle injuries are more common in sports other than running, a runner can sprain the joint (sometimes severely) by tripping. This can happen on uneven surfaces, especially in the evening when visibility is poor.

The ligaments are not very elastic, although they do have some flexibility, so they cannot naturally lengthen to withstand the stress placed on them. If you roll your ankle while running, the pressure on the ligament will be enormous (remember, a ligament is a fibrous band of connective tissue that holds bones together in a joint). The result is a sprain or, in the worst case scenario, a tear in the ligament where it is completely torn from its attachment point.

Three ligaments are usually damaged in the ankle joint. And the most vulnerable of them is the anterior talofibular ligament. Immediately after an injury, it can sometimes be difficult to distinguish between a sprain and a tear because the swelling and pain prevent you from properly palpating the joint. This can only be done under general anesthesia. But this option is used extremely rarely.

The general philosophy for treating sprains comes down to four words: rest, ice, pressure bandaging and high leg position. These are the main components of treatment, at least in the first 3 days. Rest will relieve the damaged area of ​​stress, which can only increase inflammation.

Ice is necessary to reduce swelling and relieve pain. It should be applied 3-4 times a day for 15-20 minutes. A pressure bandage prevents further development of swelling and internal bleeding. When the leg is in an elevated position, the outflow of venous blood and lymph is facilitated and swelling is reduced, which allows you to maintain some mobility of the joint.

If one of the ligaments is damaged, the ankle is bandaged in a special way - applying a tight 8-shaped bandage. It perfectly supports the ankle joint and allows the patient to transfer weight to the injured leg much earlier than when applying a conventional elastic bandage. The leg has to be bandaged for about a month, although the bandage is removed from time to time to examine the site of the injury and allow the skin to “breathe.”

If treatment is started immediately, physical therapy can be used 2-3 weeks after the injury, even for moderate/severe injuries. Laser therapy has also proven itself well. In combination with stretching exercises, it allows you to quickly return full mobility to the ankle. It is important to know that special exercises are needed to restore ankle proprioceptors. Proprioceptors are nerve endings that control changes that occur in the body during movement, especially during muscle activity. When the ankle joint is injured, the proprioceptors are also damaged, and the ankle appears to weaken. I would like to receive $100 every time another patient repeats the words of some specialist that the area of ​​\u200b\u200bthis joint is not healing well because the ligament has not returned to normal. In most cases, the ligament has healed well, but the proprioceptors still do not inform the foot where the rest of the leg is moving. As a result, when walking, the foot steps in the wrong place. The result can be painful or comical, depending on your role - the victim or the not-so-friendly spectator.

By the way, the question about ankles is often asked by people who run indoors or on short treadmills outdoors.

If you are constantly running on a track where there are 2 or more laps of a mile, you will put much more stress on your ankle joints than running in a straight line or in a quarter mile circle.

Indoor tracks are often noticeably curved at corners to give runners the opportunity to conserve energy and perform well. At a high running pace, the curvature of the surface creates excessive pronation of the leg and foot that is higher when turning. So it is quite possible to aggravate an existing biomechanical deficiency or to “earn” it. Excessive pronation will gradually result in excessive tension in the muscles, tendons and ligaments of the ankle joint and other areas of the leg and foot.

If you're running indoors, try to find one where the tracks aren't too curved. Also, change the direction of your running frequently to avoid overloading one leg. You may disturb someone, but it's better than getting pain in your ankles or knees. But even if you follow all these recommendations, you can end up with injury.

As you know from Chapter 4, synovitis is an inflammation of the outer lining of a joint. Occasionally, poor pronation causes the tibial head to intrude into the ankle joint, especially in runners whose biomechanical problems are exacerbated by the constant contact of their feet with hard pavement. The result may be synovitis of the ankle joint. Ice, ultrasound and other forms of therapy will not give a good result in the long term, since the cause of inflammation lies in biomechanics. The best way to permanently get rid of synovitis caused by biomechanical errors is good orthopedic shoe inserts.

We talked in detail about tarsal tunnel syndrome in Chapter 7, in particular how difficult it is to diagnose. This condition involves entrapment of the posterior tibial nerve at the deltoid ligament on the medial/inner side of the foot.

The runner begins to experience numbness and tingling at the site of the pinched nerve, as well as on the sole and underside of the fingers, because excessive pronation strains the ligament, which, in turn, puts pressure on the nerve. True, symptoms begin to appear after 5–7 km of running, so the diagnosis is easy to make only if the runner, after a heavy and painful exercise, runs straight into the doctor’s office.

As noted in Chapter 7, the main treatment for tarsal tunnel syndrome is proper running shoes and orthotic devices. In rare cases, the inflammation of the pinched nerve is so severe that only surgery can widen the tarsal canal and/or redirect the nerve through a less constricted area.

Running does not forgive violations of pronation. A non-runner does not experience any symptoms even at five degrees of pronation, but a runner experiences discomfort already at three degrees. I have rarely seen tarsal tunnel syndrome in non-athletes. Fortunately, only 5-6 runners with this syndrome come to me every year.

The Achilles tendon attaches to the heel bone and passes into the gastrocnemius and soleus muscles of the calf. Inflammation of the Achilles tendon develops for two reasons: the tendon gradually shortens due to constant wearing of high-heeled shoes or twisting due to excessive pronation. For female athletes, both reasons may be relevant.

All the details of this disease were discussed in Chapter 7. If the underlying cause of achillesitis is poor pronation, neither stretching nor physical therapy will help correct the biomechanical error. The treatment plan must include an accurate assessment and correction of the pronation that caused the inflammation. The optimal solution is good shoes with orthopedic inserts.

As with other diseases of the lower extremities, it is very important to begin proper treatment of inflammation of the Achilles tendon when it has not yet become acute. Due to poor circulation, the healing process is complicated and delayed. I am not a proponent of treatments such as heel pads, anti-inflammatories in tablets or injections, or surgery to remove “calcium buildup.” They simply do not solve the main problem - impaired pronation. With proper treatment using orthopedic devices, inflammation of the Achilles tendon can be cured within a few weeks. After this, periodic attacks of pain may occur, which can be relieved by applying ice. But nothing serious is happening that would make you stop playing sports.

Like plantar fasciitis, shin splints is actually periostitis (a tear of the bone membrane from the bone itself). It is localized between the knee and ankle joint (see Fig. 11.1). As I said before, shin splints were very common among intense aerobics exercisers, but runners were much less likely to experience this overuse syndrome.

There are two types of this disease: medial (posterior tibial) and lateral (anterior tibial) syndrome. It depends on where and which muscle of the leg “tears” the periosteum from the bone.

The tibialis posterior muscle runs along the inside of the leg from the shin bone to the foot. Below, its tendon is attached to the tuberosity of the scaphoid, to all three cuneiform bones, as well as to the base of the IV (sometimes V) metatarsal bone. This is the main muscle responsible for “antipronation,” i.e., protecting the lower leg and foot from excessive pronation. However, if impaired pronation is observed in the forefoot, the tibialis posterior muscle and its tendon are “overloaded,” especially during intense physical activity - running and aerobics.

An “overloaded” tibialis muscle becomes tense. Her tendon is stretched greatly to keep from tearing.

Because the tendon is more firmly attached to muscle than to bone, the posterior tibial tendon pulls on the tibia. The periosteum is torn away from the bone, and painful periostitis – “shin splints” – develops.

If this syndrome is left untreated and you continue to exercise, the posterior tibial tendon will gradually rupture and the foot will become completely flat. Excessive pronation will be very severe and will affect the ankle. This condition is very difficult to treat and may require surgery to restore ankle function and prevent overpronation. But surgery limits the normal range of motion in the joint. Therefore, it would be wise to prevent such an injury or at least begin treatment for it immediately.

The second type of syndrome is anterior tibial syndrome. As you can see in the picture, the tibialis anterior muscle runs along the outer surface of the leg and foot from the lateral condyle of the tibia to the metatarsals.

It also plays the role of an “anti-pronation” muscle and can suffer from impaired pronation of the foot. But anterior tibial syndrome is more often caused by a problem with the muscle itself, rather than the foot. Naturally, pain with this type of syndrome is felt on the outside of the leg.

Correcting impaired pronation and avoiding overloads serve to prevent the syndrome or at least prevent it from developing into a severe form. If the problem has already arisen, the first step in treating shin splints is a computer analysis of gait followed by correction of altered pronation using orthopedic means. Further treatment may consist of reducing inflammation with rest, ice, ultrasound, and possibly laser therapy.

As I already noted, improper treatment can lead to tendon rupture. It can also result in a march fracture of the tibia or fibula. Here you need to understand that the formula “you have to pay for everything” is not very suitable for playing sports. Pain is a signal that something is going wrong, not a call to increase the pain threshold.

If you are not an athlete or a doctor, you may have never heard of this syndrome. This disease can be mistaken for tibial syndrome, because, as can be seen in Fig. 11.2, the anterior interfascial space is located on the front of the leg.

In sports medicine, interfascial space syndrome can mean different things. Any pain in this area, such as anterior tibial syndrome, is now diagnosed as anterior interfascial space syndrome. As follows from Fig. 11.2, there are many muscles in the anterior section, and between them there are other, smaller sections. When some muscles become inflamed and swollen, pressure on these parts increases. This in turn causes a slight decrease in blood flow and therefore some pain.

In 99% of such cases, surgery is not required. Acute anterior interfascial space syndrome—when blood is prevented from flowing there due to a pinched artery—is an emergency. Nowadays, however, the term anterior interfascial space syndrome is often used to describe other conditions such as shin splints.

For mild cases of the disease, discomfort and inflammation can be reduced by resting, applying ice, and performing gentle stretching exercises. But if the underlying cause is not eliminated, a relapse is possible. The most common causes are poor biomechanics of the lower extremities; inappropriate shoes; ineffective or insufficient warm-up, stretching, relaxation exercises; overload. I advise all runners, and especially elite athletes, to pay attention to the need to stretch before and after exercise.

This will help avoid anterior interfascial space syndrome, especially if you have biomechanical abnormalities.

If, despite all efforts, the syndrome does not respond to treatment, surgery is required to reduce the pressure in this section, that is, to increase the space through which the compressed blood vessel passes. But this happens rarely. There is no need to worry too much if you have been diagnosed with the syndrome but have not yet done everything necessary to keep it under control.

The most common term for chondromalacia patella is “runner's knee,” as the condition is associated with the jogging craze that began 30 years ago. Chondromalacia (irritation of the surface between the kneecap and the cartilage underneath) is caused by imperfect biomechanics of the legs and feet. In runners, the patellar tendon is pulled inward as a result of poor pronation and rotation of the lower leg in the same direction. At the same time, the upper leg rotates outward—which is normal—and cannot compensate for the poor pronation of the lower leg. Thus, the upper part of the leg twists the knee joint outward, and the lower part inward. As can be seen in Fig. 11.3, the kneecap generally moves up and down the groove between the medial and lateral femoral condyles, which are the rounded projections of the femur. External rotation of the femur with simultaneous internal rotation of the patella tendon pulls the cap out of the confines between the condyles. When this happens, the kneecap begins to rub against the condyles, and the cartilage on the back of the kneecap experiences severe abnormal wear and tear.

Typical symptoms of chondromalacia patella are:

Sharp pain at the top of the kneecap, especially when walking up stairs;

Stiffness of the knee joint after two or more hours of sitting with a bent leg and transferring weight to this leg;

Restricted mobility of the knee joint, leading to a narrowing of the normal range of motion.

Treatment of chondromalacia patella, regardless of the degree of the disease, should include orthopedic devices to compensate for excess pronation. It is imperative to conduct a computer analysis of gait, which gives a picture of the biomechanics of the foot and leg in motion and allows you to make an accurate diagnosis and select the correct treatment. Sometimes orthotic devices are combined with therapy to relieve inflammation and strengthen leg muscles. Surgery is indicated only if the disease is advanced and the damage to the knee joint is irreversible, that is, the cartilage is almost completely worn out and one bone rubs against the other.

As with all other diseases caused by overuse, the athlete should stop exercising if it causes him pain. They would lead to further destruction of the knee joint and prolong the healing process or jeopardize the very ability to play sports.

Although runner's knee is not always visible on x-rays, especially in the early stages, the disease has very specific symptoms. Treatment depends on the causes that caused the condition, the combination of which leads to dysfunction of the knee joint: weak or inadequately functioning quadriceps femoral muscles, imperfect biomechanics of the foot and lower leg, dysfunction of the knee tendon. I will focus on biomechanical issues.

An overpronated foot rotates the knee inward. This puts additional stress on the knee. As the leg tries to compensate for poor pronation, the kneecap deviates from its normal “route” along the groove. Another factor leading to the disease is poor connection of the patella tendon to the knee joint. It can also be the result of impaired pronation, weakening the connection while compensating for biomechanical errors.

Runner's knee can also occur for rarer reasons. Perhaps the athlete is jogging in ill-fitting shoes or on uneven or curved surfaces. Running up and down rough terrain also puts stress on the knee, which constantly bends to accommodate the incline. It has been scientifically established that when running uphill, the leg receives a load that is 3 times higher than normal, and when descending from a mountain – 5 times. Therefore, it is clear that runners and serious athletes are much more likely to experience leg and foot problems than “non-athletic” people.

Once a diagnosis of runner's knee is made, I must determine the cause of the condition. Then I tell the patient about ways to correct his condition and prescribe therapy. If the reason is biomechanical, you need to choose good sneakers and orthopedic inserts (sports shoes will be discussed in detail in Chapter 15).

Many people with runner's knee use a variety of knee braces, straps, and braces to help keep the knee joint in the correct position. These devices may relieve minor pain, but will not address the underlying cause. If you have problems with your knees, it is better to consult a doctor.

Runners with a slight bowing of the shin at an angle that opens inward, called an “adducted shin,” or a strain in the opposite direction (“abducted shin”) often experience problems that are not typical in normal walking. Of course, this is due to the additional stress on the legs when running on hilly or simply uneven surfaces.

One of the emerging problems is osteoarthritis of the knee joint. If a runner has an O-shaped shin (“adducted shin”), the weight of the entire body is transferred to the medial (inner) knee joint as the foot is inverted to compensate for the abnormal shape of the leg. If the shape of the legs resembles the letter X (“abducted shin”), excessive pronation is created, and the body weight is transferred to the lateral (outer) part of the knee. Naturally, the overloaded part of the knee wears out, while the other remains unchanged. Osteoarthritis of the knee joint creates serious discomfort. The diagnosis is usually confirmed by X-ray examination of the knee joint.

Treatment consists of relieving inflammation with physical therapy and/or anti-inflammatory tablets. At the same time, it is necessary to solve the problem with biomechanics. Orthopedic devices compensate for excessive pronation and impaired supination and help keep the legs as straight as possible. It is important to do stretching exercises for the quadriceps and hamstrings, as they also support the legs in the correct position. If the damage to the legs is irreversible, you can resort to the achievements of modern surgery.

And again, athletes should not forget that knee pain is a serious reason for an immediate visit to a doctor, who will identify the cause of the problem and prevent it from developing into a disease of the knee joint.

The iliotibial tract is a thickened part of the fascia lata that runs along the lateral surface of the thigh from the superior anterior iliac bone to the lateral condyle of the tibia. One of the functions of this band is to prevent the leg and hip from rotating inward, which is vital for runners because they put a lot of stress on their legs with every step.

When the iliotibial tract is overstretched, inflammation develops due to friction at the site of contact with the kneecap. A foot with severe overpronation creates an inward rotation of the leg, and this is an additional load on the tract. Sometimes iliotibial band syndrome triggers running over rough terrain or uneven surfaces.

The syndrome is characterized by pain and increased sensitivity on the outer side of the knee, at the head of the fibula and above. Symptoms resemble runner's knee: pain when going up and down stairs; after a long period of immobility in a bent position, the knee becomes rigid. But the pain is localized on the outside of the joint. According to some experts, discomfort is caused by inflammation of the bursa, a small sac of fibrous tissue filled with synovial fluid. It is usually located where ligaments or tendons rub as they pass through bones. This particular “pouch” is located between the iliotibial band and the lateral side of the knee joint.

To treat iliotibial band syndrome, you need a program of stretching exercises; ice or ultrasound to reduce discomfort; replacement of shoes; possibly orthopedic devices.

The sciatic nerve runs from the spinal column down the leg. With sciatica, it is pinched in the lumbar spine or lower in the leg. This syndrome is characterized by pain, sometimes numbness and a tingling sensation in the leg and fingers.

Until a few years ago, it was believed that sciatica was the result of the sciatic nerve being pinched by a protruding disc or an abnormal part of the spinal joint in the lumbar region.

But it is now widely believed that nerve entrapment can also occur in the upper leg, particularly where the nerve passes under the piriformis muscle (see Fig. 11.4). This muscle keeps the femur from rotating inward, which occurs in runners with poor leg biomechanics. When the femur rotates excessively, additional stress is placed on the piriformis muscle. The muscle tenses and presses on the sciatic nerve. The nerve becomes inflamed, pain spreads from the site of inflammation in the buttocks down the leg, behind the knee, into the foot. This is called piriformis syndrome.

In my clinical experience, correction of internal rotation of the femur with orthopedic means can help manage pain. Naturally, this method of treatment is possible only after a thorough examination of the patient and exclusion of problems with the lower back. I also advise runners to do a set of exercises to stretch the piriformis muscle, which helps prevent sciatic nerve entrapment. A good physical therapist will tell you the exercises you need to do.

A growing body of research supports the theory that piriformis syndrome is the cause of sciatic pain. I suspect that, as with runner's knee, we will hear a lot more about this disease in the coming years. Running is growing in popularity and becoming more common.

Sometimes the cause of such pain is a specific injury, but often it is not possible to identify the true cause of the pain.

Symptoms and signs of shin splints

With shin splints, pain may occur in the front and back of the lower leg when activity begins, but then subsides as activity continues. Pain that persists at rest suggests another cause, such as a tibial stress fracture.

Diagnosis of shin splints syndrome

• Usually according to the clinical picture.

The examination usually reveals localized tenderness in the area of ​​the anterior muscle lacunae, sometimes pain on palpation of the bone.

Regardless of the cause of the pain, X-ray results are often unclear. If a stress fracture is suspected, a bone scan may be necessary.

Exercise-induced compartment syndrome is diagnosed by an increase in internal compartment pressure measured during exercise.

Treatment for shin splints

• Changing the type of physical activity.
• Stretching exercises for the piriformis muscle, NSAID medications.

You should stop running until it stops causing pain. Early treatment includes ice, NSAID medications, and exercises to strengthen the anterior and posterior calf muscles. During periods when rest is the primary treatment, fitness can be maintained through cross-training such as swimming, which does not require constant weight bearing on the limbs.

Once symptoms have subsided, return to running should be gradual. Shoes with a rigid back and arch support help support your foot and ankle while running, aid recovery, and help prevent future symptoms. Exercises to strengthen the anterior calf muscle by dorsiflexing the ankle joint under resistance (for example, with a resistance band or on a special machine) increase the strength of the lower leg muscles and help prevent lower leg pain.

Shin splints often occur in runners who misbalance the load during physical activity. This causes stretching of ligaments and muscles. The name of the syndrome is associated with a pronounced clinical picture that occurs immediately after running.

Causes of pathology

The syndrome most often affects professional runners, which is associated with deformation of the heel when the heel repeatedly hits the ground during physical activity. The ankle joint is also a high-stress area. The risk of pathology increases with injuries to large joints, as well as with flat feet.

Overstrain of the muscles and tendons of the surface of the lower leg occurs, which contributes to the appearance of the syndrome. Chronic joint diseases increase the risk of developing pathology. A provoking factor is jogging without prior warm-up, as well as wearing uncomfortable shoes that unevenly distribute the load.

Symptoms

Symptoms of the syndrome are always pronounced:

1. Severe pain occurs, which resembles that which occurs with a fracture.
2. Under heavy load, the tendon pulls on the periosteum so that it moves.
3. The person feels severe discomfort.
4. The inflammatory process can cause swelling in the affected area.
5. The mobility of the joint is limited, lameness appears.

Diagnosis is often made using CT or MRI. At the same time, the patient assures that he has, but the pictures show only displacement of the periosteum. If a ligament rupture is added to the syndrome, the pain intensifies. Redness of the skin appears over the damaged area.

Additionally, there may be numbness in the toes, which is an alarming sign. At night, cramps may occur, which disappear after complex treatment. There is a feeling of tension in the ankle joint. Additionally, there may be aches in large joints. The pain often intensifies during movement, when trying to walk or run.

Treatment measures

Treatment consists of the use of thermal procedures, anti-inflammatory and painkillers.

It is important in therapy to ensure complete rest of the affected limb.

Knowing how to bandage a leg at home can help alleviate symptoms. It is best to do this only in the initial stages. An elastic bandage is suitable for the procedure.

Warm compresses with clay will help relieve pain. To do this, you need to purchase the product at any pharmacy. You can use white, black or blue clay, which must first be diluted with warm water to the consistency of sour cream. Then apply to the area of ​​pain and leave for 10 minutes under plastic wrap. The procedure should be repeated daily.

Non-steroidal anti-inflammatory drugs produce a good therapeutic effect. It is best not to take them orally, but to use them topically in the form of ointments and gels. To relieve pain and eliminate inflammation, Diclofenac, Nise, Dilogel, etc. are most often prescribed. Ointments and gels should be applied over the affected area 2-3 times a day.

For pain relief, you can take analgesics orally: Tempalgin, Baralgin, etc. Such drugs can reduce the manifestations of unpleasant symptoms. After the pain subsides, you can begin doing exercises that will help restore motor activity.

It is necessary to slowly rotate the foot in the ankle joint clockwise, then bend and straighten the fingers of the problematic limb.

Massage can be done during the recovery stage, but this does not mean that the movements should be intense. You can knead the ankle area by rubbing, pinching, etc. In this case, you can use pain-relieving ointments: Bystrum gel, Voltaren, etc. Such topical products will enhance the effect of the massage. If pain intensifies during the procedure, then it is better to abandon this type of therapy for a while.

Additionally, physiotherapy procedures can be used:

1. Laser therapy produces a good effect, which improves blood circulation in the affected area and eliminates the inflammatory process. The sensor is placed over the painful point, the procedure is carried out within a few minutes.
2. Mud wraps and paraffin therapy warm up the problem area and help speed up recovery.
3. Electrophoresis with hydrocortisone helps to get rid of severe pain if carried out daily.

Conclusion

If you do not start treatment in time, you can provoke paresthesia of the foot, which in the future will lead to problems with gait. The leg will twist all the time. When the first signs of the syndrome appear, you should immediately contact a surgeon.

Shin splints syndrome is an intermittent, severe pain that occurs during intense physical activity. The condition is named for the similarity of the nature of pain with fractures. The unpleasant syndrome disappears after local treatment I, but it may unexpectedly return on the next run, so it is important to identify and rule out its cause.

Shin splints cause pain after running

Clinical symptoms of shin splints are associated with motor overload or excessive running pace, which causes forced muscle contractions. This is not a typical muscle strain, but the symptoms are very similar. The pain radiates to the anteromedial surface of the distal third.

In this case, such severe pain occurs that the person suspects a fracture.

When the muscles of the posterior group are stretched, the pain is localized at the site of their attachment to the osteoarticular joint.

Over time, if measures are not taken, periostitis forms on the tibia. It causes the same severe pain as a fracture, the pain is so sharp and acute that a person falls from surprise and may lose consciousness.

Types of manifestations of the syndrome

An inflammatory process begins on the periosteum due to the fact that the bone shell is torn away from its base. This most often occurs along the medial edge of the tibia. This is exactly what one of the manifestations of shin splints syndrome looks like.

There is no bone splitting as such, and the name comes from the similarity of symptoms.

X-ray and CT images show the area where the shell has been torn away from its attachment point on the bone. The pain is localized either in front of the tibia, or behind it, behind it. Thus, there are two types of tibial pain syndromes:

• rear;
• front.

They most often occur from high loads while running. Muscles from overload come into a state of excessive tension, the tissues of their tendons are stretched to a critical state, threatening to rupture. But physiologically, the leg is designed in such a way that the tendon is more firmly attached to the muscle tissue, so it pulls the bone along with it, which causes the periosteum to tear off. This, in turn, leads to the formation of periostitis on the posterior side of the tibia.

It must be treated promptly and effectively and not return to training, otherwise the tendon may rupture.

With anterior type tibial syndrome, the toes are more affected because many of the anterior muscles extend their base into the phalanges of the toes, that is, to the medial part of the foot. With inflammation or swelling of the muscles of the medial group, the pressure and load on other muscles of the leg increases, which is facilitated by the small distance between the fascia. This impairs blood circulation and brings pain or at least discomfort.

At the same time, sports physicians express their own opinions regarding the definition of “shin splints.” The views of classical and sports medicine differ in interpretation; this condition has many other names: inflammation of muscle tissue, minor damage to muscle tissue, separation of tissue from the bone, and even traumatic injury to the tibia.

Causes of pathology

Taping the calf muscle

It’s not without reason that this syndrome is recognized as a runner’s disease. While running, the foot hits the track hard with the heel. In this case, the tibia bears such a load that the naturally straight bone bends slightly from the stress of the impact. A little, it's a completely minor bend.

However, if it is repeated constantly and for a long time, it leads to thinning of the bone tissue in this place. This causes constant bone pain or even leads to microcracks in the bone tissue.

During running, the legs experience high rotational loads.

These same loads have a negative effect on the foot, its small bones and ligaments. As a result, there is an overload of the calf muscles, the attachment of which goes directly into the ankle joint and into the foot. If the foot itself has congenital or acquired defects - pronation, flat feet, then this only aggravates the situation and increases the risk of shin splints syndrome.

After class, do not stop abruptly. You need to smoothly switch first to a slow run, then to a walk, until the muscles cool down. It is important to use only suitable shoes for training.

Treatment for shin splints

Hip replacement

The first thing the traumatologist prescribes is to limit movements and provide complete rest to the injured leg.

Treatment is symptomatic: local thermal procedures, injections of anti-inflammatory and, if necessary, painkillers.

A few days of warmth and rest - and you can gradually return to your usual mode of physical activity.

In case of relapse of the disease, one must be wary of paresis or paresthesia, which can affect the deep-lying peroneal nerve. Such damage is often irreversible and leads to unpleasant restrictions on movement. The foot sags, the person begins to “drag” the leg.

A more complex form is loss of sensation in the leg, after which ischemic tissue necrosis occurs with the replacement of muscle cells with scar tissue. This is why shin splints syndrome is dangerous: if treatment is aimed only at eliminating symptoms, without a comprehensive examination of all parameters, this can lead to serious consequences.

Trauma practice shows that both physiotherapy methods and anti-inflammatory treatment are effective, but when a person resumes training, the pain immediately returns.

When faced with such a syndrome, you should think carefully about the advisability of walking and running and, together with an experienced trainer, choose more acceptable methods of training. The only way to prevent shin splints is to limit your exercise.