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HEEL PAIN SYNDROME (Plantar Fasciitis)
Heel pain can be attributed to a variety of conditions but one of the common problems encountered is plantar fasciitis or heel spur syndrome. Often there is no history of specific injury that has precipitated the problem.
It is found in runners, but also in those who are more sedentary or obese. Pain is commonly worse first thing in the morning when, after a period of overnight rest, there is sudden stretch and contraction of the plantar fascia. Sharp pain is usually felt along the medial aspect and across the central heel.
Although it is a self-limiting condition, various therapies are recommended when the pain is particularly limiting: heel inserts (made of silicon or polymer gel eg Silipos) provide shock absorbency; corticosteroid injections may be used to reduce inflammation, as will prescription of non-steroidal antiinflammatory drugs such as Ibuprofen. It is important to ensure that footwear is not too flexible and that the shank is firm. An Aircast boot may be offered- this is used to offload pressure on the heel. Gentle calf stretches and a slight heel raise in the shoe may also help relieve symptoms. Biomechanical assessment of the patient may be undertaken and in the event that an excessive degree of pronation is identified (medial rolling of the foot often with lowering of the medial arch) issue of an orthotic with appropriate supplementary wedge / archpad provision will often help.
SHIN SPLINTS (Compartment syndrome)
The term shin splints refers to an aching or cramping pain felt anywhere in the front, sides or rear of the lower leg, associated with exercise. Pain is usually felt either 3-12 centimetres above the ankle on the inside of the calf or at the upper end of the shin. It is a common problem in runners when abnormal foot mechanics influence lower limb function. The term is applied to pain induced by a variety of conditions such as stress fractures, soft tissue injuries and periostitis – this latter is inflammation of the tissue that closely encases the bones. Mechanical factors, such as tight calf muscles and excessive pronation, can promote the condition. When these are linked to repetitive impact on hard surfaces, over training and wearing of footwear without adequate shock-absorbency, the pain is produced.
Management consists of reducing training, undertaking non-weightbearing exercise eg swimming, cycling, pool running and use of non-steroidal antiinflammatory drugs. In addition, stretching of the calf muscles and use of a heel-raise in the shoe to diminish traction may help. In the event that biomechanical assessment shows a problem with leg or foot alignment, prescription of orthoses may assist in reducing symptoms.
