Occupations, Activities and Causes of Foot Disorders
| Plantar Fasciitis | Bunions
| Achilles Tendonitis | Arthritis
| Diabetes | Metatarsalgia | Posterior
Tibialis Tendonitis |
Occupations, Activities and Causes of Foot Disorders
of Foot Disorders:
The plantar fascia is actually a thick, fibrous band
of connective tissue which originates at the heel bone and runs
along the bottom of the foot in a fan-like manner, attaching to
the base of each of the toes. A rather tough, resilient structure,
the plantar fascia takes on a number of critical functions during
running and walking. It stabilizes the metatarsal joints (the joints
associated with the long bones of the foot) during impact with the
ground, acts as a shock absorber for the entire leg, and helps to
lift the longi-tudinal arch of the foot to prepare it for the 'take-off'
phase of the gait cycle
Although the fascia is invested with countless sturdy 'cables'
of connective tissue called collagen fibres, it is certainly
not immune to injury. Plantar fasciitis, the most common cause
of heel pain, may have several different clinical presentations.
Although pain may occur along the entire course of the plantar
fascia, it is usually limited to the inferior medial aspect
of the calcaneus, at the medial process of the calcaneal tubercle.
Often tend to occur near the heel, where stress on the connective
tissue fibres is greatest, and where the fascia itself is
the thinnest (it tends to broaden out as it reaches toward
the toes). This bony prominence serves as the point of origin
of the anatomic central band of the plantar fascia and the
abductor hallucis, flexor digitorum brevis and abductor digiti
Plantar fasciitis is often referred to as "heel spur
syndrome" in the literature and the medical community,
but the label is a misnomer. This vague and nonspecific term
incorrectly suggests that osseous "spurs" (inferior
calcaneal exostoses) are the cause of pain rather than an
incidental radiographic finding. There is no correlation between
pain and the presence or absence of exostoses,1 and excision
of a spur is not part of the usual surgery for plantar fasciitis.2
Plantar fasciitis occurs in both men and women, but is more
common in the latter. Its incidence and severity correlate
strongly with obesity.
Palpation of the medial calcaneal tubercle
usually elicits pain in patients presenting with plantar fasciitis.
Plantar Fasciitis often leads to heel pain, heel spurs, and/or
arch pain. The excessive stretching of the plantar fascia that leads
to the inflammation and discomfort can be caused by the following:
- Over-pronation (flat feet) which results in the arch collapsing
upon weight bearing
- A foot with an unusually high arch
- A sudden increase in physical activity
- Excessive weight on the foot, usually attributed to obesity
- Improperly fitting footwear
- Increased raising of arch such as occurs when shoveling or climbing
Most cases of plantar fasciitis are the result of a biomechanical
fault that causes abnormal pronation. This pronation significantly
increases tension on the plantar fascia.
Other conditions, such as bowed shins, tight calves, and limb length
inequality, can cause an abnormal pronatory force on the long limb.
Increased pronation with a collapse produces additional stress on
the anatomic central band of the plantar fascia and may ultimately
lead to plantar fasciitis.
Patients usually describe pain in the heel on taking the first several
steps in the morning, with the symptoms lessening as walking continues.
They frequently relate that the pain is localized to an area that
the examiner identifies as the medial calcaneal tubercle. The pain
is usually insidious, with no history of acute trauma. Many patients
state that they believe the condition to be the result of a stone
bruise or a recent increase in daily activity. It is not unusual
for a patient to endure the symptoms and try to relieve them with
home remedies for many years before seeking medical treatment.
Even in this age of modern technology, the diagnosis of plantar
fasciitis is based mainly on the medical history and clinical presentation.
Direct palpation of the medial calcaneal tubercle often causes severe
pain (see Figure above). The pain is generally localized at the
origin of the anatomic central band of the plantar fascia, with
no significant pain on compression of the calcaneus from a medial
to a lateral direction. Standard weight-bearing radiographs may
show other osseous abnormalities such as fractures, tumors or rheumatoid
arthritis in the calcaneus. However, radiographs usually serve only
as an aid to confirm the clinician's diagnosis.
Conservative treatment of plantar fasciitis should address the inflammatory
component that causes the discomfort and the biomechanical factors
that produce the disorder. Patients should learn about recommended
changes in daily activities,
such as wearing appropriate shoes
with a significant medial arch while walking. Patients whose symptoms
are associated with a recent increase in exercise should adopt a
less strenuous regimen until
the plantar fasciitis resolves. An ankle/foot strengthening
and stretching program will help to prevent recurrence
if this is the cause.
To serve as a temporary medial arch support to decrease pronation
during midstance of the gait cycle the patient can be fitted with
a removable pad or a medial
arch pad directly against the patient's skin with taping
the patient's foot from a plantar medial to a plantar lateral direction
that.These temporary devices provide greater biomechanical support
than over-the-counter heel cups or heel pads. If a patient has significant
plantar fasciitis pain secondary to a limb-length inequality a simple ¼" heel lift in
the shoe of the short limb may provide temporary relief. One-sided
tight calf might feel better with a bilateral heel lift.
Orthotic devices are the mainstay
of ongoing conservative treatment for patients with plantar fasciitis.
The biomechanical factors that cause the abnormal pronatory forces
stressing the medial band of the plantar fascia must be corrected.
Patients with high arched feet may benefit from using a flexible
orthotic device with an additional heel cushion. This prescription
orthosis can disperse some of the force experienced on heel strike,
while maintaining biomechanical support for propulsion.
Stretching the Achilles tendon
and hamstrings is beneficial as adjunctive therapy for plantar fasciitis.
This can be done in conjunction with arch stretching by pulling
back on the toes or rolling a can or ball back and forth under the
arch. Most popular time that this is helpful is prior to rising.
Seeing a massage therapist good
with fascial stretching techniques can also help.
Each night for 10 to 14 days, the patient should apply an ice pack
to the plantar aspect of the heel 15 to 20 minutes before going
to bed.or massage the plantar fascia with an ice
block (made up of water frozen in a paper cup).
It is often advantageous for patients with no contraindication
to take a nonsteroidal anti-inflammatory
drug (NSAID) for six to eight weeks. We believe that
corticosteroid injections should
be avoided in the initial treatment of plantar fasciitis; we recommend
themonly as supplemental treatment in patients who have resistant
chronic plantar fasciitis after achieving adequate biomechanical
control. These injections may provide only temporary relief and
can cause a loss of the plantar fat pad if used injudiciously.
Night splints that maintain
the foot at an angle of 90 degrees or more to the ankle have recently
been used as adjunctive therapy for plantar fasciitis. These orthoses
prevent contraction of the plantar fascia while the patient sleeps.
One study showed relief of recalcitrant plantar fasciitis pain in
83 percent of patients treated with such splints.
Shock wave or laser therapy can sometimes help to increase blood
flow to stimulate the healing process.
Some clinicians advocate the use of a short-leg
walking cast for several weeks as a final conservative
step in the treatment of plantar fasciitis.
features combine to create the infamous bunions that are the plague
of every woman who loves to wear tight fashion shoes. Like many
of our physical features, bunions tend to be inherited, but get
worse with time. Severe bunions can be seen even in 12 year olds,
but rarely in males. In the diagram above you can see the big toe
joint going out of shape with the typical large bump (subluxed joint
and thickened bursa), the widened foot and the end of the toe angling
The shape of the foot however, does not usually have much to do
with the pain of a bunion. Bunion pain is most often caused by the
wider foot and its prominent bump rubbing against the side of the
shoe. The bursa (a small, flat, fluid-filled sac that lies just
below the skin on the outside of the bump), becomes inflamed and
thickened. Even shoes that you once thought were loose may be tight
enough to create a great deal of pain. Wearing wider shoes usually
eliminates the pain, but the bump makes fitting tight shoes very
Surgery is the only alternative to reduce the size of the bump
and the hallux valgus angle. There are several different procedures
which have both pros and cons . Most patients will try other methods
of managing the condition initially.
Bunion formation is likely accelerated by hyperpronation (excessive
lowering of the arches) because of the excessive weight placed on
the big toe joint during the pushoff phase of gait, forcing the
hallux into further valgus. More friction between the bursa and
the shoe occurs with a hyperpronated foot. Once the hallux valgus
angle is significant it destabilizes the foot during push-off since
the great toe is not available for push off.
What to Do
The pain of hallux rigidus (osteoarthritis of the great toe) or
conditions like gout can sometimes mimic the pain of bunions so
see your doctor for a proper assessment. Tight, pointed toeboxes
force the hallux into greater valgus for hours at a time and should
therefore be used in moderation. Shoes should be devoid of seams
since stitching does not stretch easily. Pumps should be high in
the vamp, covering the bunion completely, rather that the more classic
style that cuts across it. Bunions that ache at night can be relieved
with ice and a bunion
splint that straightens the toe temporarily.
Constant use of a hallux valgus night splint may reduce the ligamentous
contractures associated with long term bunions. Gel
toe spreaders may also provide relief. Pre-stretch the bunion
area at the shoe repair shop rather than make your foot do the work,
or purchase a "ball and ring" stretcher made for that
purpose. Wear a heel height that is comfortable, and wear supportive
walking or running shoes with a roomy toebox whenever possible.
Wear orthotics or arch supports as your doctor prescribes them to
What is it?
- The achilles tendon (common tendon for gastrocnemius and soleus
muscles, which unite distally to form it in conjunction with the
plantaris muscle that lies between the gast. and sol.) is the
large tendon located in the back of the leg that inserts into
the heel. Achilles tendonitis is an inflammation of that tendon.
- Achillies tendonitis should not be left untreated due to the
danger that the tendon can become weak and ruptured.
Signs and Symptoms
- Pain and swelling over the tendon and inability to perform.
- Local tenderness on squeezing the tendon.
- Crepitus may occur
- Pain with forced passive dorsiflexion, resistance to active
plantar flexion, or both.
- Often complaint is that the first steps out of bed in the morning
are extremely painful. Another common complaint is pain after
steps are taken after long periods of sitting. This pain often
lessens with activity.
What causes it?
- Achilles tendonitis can develop gradually without a history
of trauma or can occur from a sudden injury.
- The most common causes are training too hard/too soon without
- Activities that repeatedly stress the tendon, causing inflammation
(such as walking, running or jumping). It is a common problem
often experienced by athletes, particularly distance runners.
- Biomechanical abnormality such as over-pronation
- Associated with a high-arch (pes cavus) foot type
- Improper shoes
- Abnormal stiffness of the calf muscle complex.
- A person suffering from Achilles tendonitis should incorporate
a thorough stretching program to properly warm-up the calf muscles.
- They should also decrease the distance and intensity of their
walk or run.
- Apply ice after the activity.
- It is best to avoid any up hill climbs, which increases the
stress on the Achilles tendon.
- Heel lifts in the shoes, anti-inflammatory medication, and ultrasound.
- Casting in extreme cases as last resort.
- Achilles tendonitis can be a difficult injury to treat due to
high levels of activity and reluctance to stop or slow down training.
- An orthotic device should be used to accommodate any biomechanical
abnormality and allow the Achilles tendon to function more normally.
- A heel lift may be recommended on a temporary basis to elevate
the heel and reduce stress on the Achilles tendon. The device
should be made with shock absorbing materials.
- Dorsiflexion night splints.
- Shoes that do not place unusual pressure on the Achilles tendon
or on its insertion site on the heel will help prevent further
What is it?
Arthritis is a disease characterized by the inflammation of the
cartilage and lining of the body's joints. Inflammation causes redness,
warmth, pain and swelling. Arthritis is often considered a disease
of the aging but can occur at any age. The primary targets for arthritis
are people over the age of 50. Arthritis is a major cause of foot
pain because each foot has 33 joints that can become affected by
the disease. Arthritis causes changes in joints and restriction
of motion. These changes and restrictions can make walking painful.
Arthritis is a general term for a variety of conditions that cause
inflammation and degeneration of the cartilage and lining of the
joints of the body. There are many different kinds of arthritis.
Some of the most common types are osteoarthritis and rheumatoid
arthritis. The term arthritis refers to more than 100 different
rheumatic diseases that affect the joints, muscles, and bones, as
well as other tissues and structures. Gout accounts for approximately
5 percent of all cases of arthritis.
What causes it?
Osteoarthritis is typically considered to result from normal "wear
and tear" or age, but can also result from previous injury
with stiffness usually occurring after periods of rest.
Rheumatoid arthritis can occur at any age and there is no known
cause for this condition. It can cause severe deformities of the
joints, especially in the hands and feet. It can develop at any
age and there is no known cause for this condition. Rheumatoid arthritis
is the most crippling form of the disease that can affect people
of all ages. It can cause severe deformities of the joints with
associated fatigue of the entire body. People who suffer from rheumatoid
arthritis often develop severe forefoot problems such as bunions,
hammer toes, claw toes, and others.
Arthritic footwear should accommodate swelling of the foot. Orthotics
designed to provide comfort, support and extra cushioning are also
recommended. Orthotics made with a material called Plastazote are
often recommended because they mold to your feet to provide customized
comfort. The proper footwear and orthotics will reduce pressure
to provide a comfortable support base.
Gout is one of the most painful rheumatic diseases. Our blood contains
a salt called uric acid. It results from deposits of excess needle-like
crystals of uric acid in connective tissue, in the joint space between
two bones, or in both. These deposits lead to inflammatory arthritis,
which causes swelling, redness, heat, pain, and stiffness in the
joints. The big toe joint is commonly the focal point due to the
stress and pressure it experiences during walking and other weight
bearing activities. This often leads to severe pain in the big toe.
Up to 60% of initial attacks occur at the first metatarsophalangeal
joint. Gout mostly affects men and is very rare in women until after
menopause when it is seen quite often.
The signs and symptoms of gout are almost always acute, occurring
suddenly - often at night - and without warning. They include Intense
joint pain swelling, and redness usually affecting the large joint
of your big toe but can occur in your feet, ankles, knees, hands
and wrists. The pain typically lasts five to 10 days and then stops.
The discomfort subsides gradually over one to two weeks, leaving
the joint apparently normal and pain-free. After the first attack
there may be intervals of many months or even years before there
are other attacks. Over time these attacks tend to become more frequent
and more severe and eventually may involve other and more joints.
There are many causes of hyperuricaemia (high uric acid levels)
- Hereditary or "Primary gout" which is a genetic disorder
of uric acid metabolism leading to high levels of serum uric acid.
The presence of urate crystals in a joint sets off an immune response
that causes the body to attack the internal components of the
joint, leading to extreme pain and eventually joint destruction.
- Secondary gout (10% of cases) from: catabolism (breakdown) secondary
to leukemias and certain other cancers or a very reduced caloric
intake; or decreased excretion of uric acid due to renal failure.
obesity; some of the drugs used to treat high blood pressure can
precipitate a gouty attack; high intake of food that contain purines
(purines are broken down into uric acid); an excessive intake
of alcohol (particularly beer); the use of diuretics: the use
of aspirin; and the low intake of water.
The crystals also have a tendency to form on a roughened surface,
such as a joint that has suffered from previous trauma, unreduced
subluxation, or degeneration.
In the acute and chronic stages, ultrasound, heat, gentle chiropractic
manipulative therapy and gentle soft-tissue massage are beneficial.
is a serious disease that can develop from lack of insulin production
in the body or due to the inability of the body's insulin to perform
its normal everyday functions. Insulin is a substance produced
by the pancreas gland that helps process the food we eat and turn
it into energy.
to the Public Health Agency of Canada, approximately 2 million
Canadians have diabetes classified into 2 different types: Type
1 and Type 2. 90% have Type 2. Type 1 is usually associated with
juvenile diabetes and is often linked to heredity. Type 2, commonly
referred to as adult onset diabetes, is characterized by elevated
blood sugars, often in people who are overweight (especially if
the weight is concentrated around the mid-section) or have not
attended to their diet properly.
- It's the
leading cause of death by disease in North America.
- With proper
nutrition and regular physical activity, you can reduce your risk
of getting type 2. Healthy eating and regular physical activity
also helps those with diabetes to help manage the disease.
- Many complications
can be associated with diabetes. Diabetes disrupts the vascular
system, affecting many areas of the body such as the eyes, kidneys,
legs, and feet. People with diabetes should pay special attention
to their feet.
does Diabetes contribute to foot problems?
40% of people with diabetes will develop complications at some
- There are
two types of complications: reduced ability to fight infection
and damage to the circulatory system, including both small and
large blood vessels.
- 25% of all
diabetic hospitalizations are for the foot.
in about 25% of people with diabetes.
disease causes a narrowing of the arteries that can lead to significantly
decreased circulation in the lower part of the legs and the feet.
- This decreased
circulation reduces the body's ability to heal itself and persons
affected by diabetes often develop sores or ulcers that can take
months or even years to heal. The lnger a sore is present, the
more likely it is that infection can enter the body causing more
- Poor circulation
can also lead to swelling and dryness of the foot.
- Signs of
stress in the venous circulation include swelling of the feet
and ankles, called "edema", or a brown discoloration
of the skin around the ankles and the lower calf, called "staining".
Problems with arterial circulation are not associated with edema
- The loss
of ability to feel pain, heat and cold. Persons affected by diabetes
who have neuropathy can have sores that they are not even aware
of due to the insensitivity.
- A person
who has neuropathy has a 60% risk for getting a foot ulcer within
the next three years.
- There are
4 basic ways that ulcers get started if you have neuropathy in
your feet. 1) Infection, 2) Big pressure, short time, 3) Little
pressure, long time, 4) Medium pressure, again and again.
is caused from bacteria getting into your skin and releasing
toxins (harmful chemicals) that eat away at your skin. Red
areas, swelling, or warm spots ignored can eventually lead
to an ulcer.
you don't have neuropathy, you may develop a foot ulcer. You may
have hardening of the arteries in your legs and feet. If so, the
circulation in your feet is poor. You may develop ischemic ulcers,
which are caused by a lack of blood-flow, which are often quite
painful. Though, you could have a painless ischemic ulcer if you
have neuropathy as well as arteriosclerosis.
injuries are left untreated, complications could arise leading
to ulceration and possibly even amputation. In one study it was
shown that 86% of amputations were attributed to initial minor
trauma causing tissue injury. 36% of these were caused by repetitive
It has been
shown that high blood sugars increase the amount and severity
of neuropathy of patients with Type 1 diabetes.
can also cause deformities such as Bunions, Hammer Toes, and Charcot
can get started with a distinct injury like stepping on a nail
that breaks the skin. This shows a good case for wearing shoes.
is when you press on your skin turning it white since you're
squeezing out the blood. If you keep this up for several hours,
the skin at that point may die because of the lack of nutrition.
Examples of this would be wearing to tight of shoes or bedsores.
- The most
popular cause of ulcers is moderate pressure that is repeated.
Particular areas that bear extra weight over 1000's of steps
each day will build corns, blisters, and calluses and eventually
the skin breaks down in that one area.
Foot is a common complication of diabetic neuropathy that leads
to a massively deformed foot that requires special care to prevent
ulceration over unusual pressure points.
- It's been
estimated that 2% of people with diabetes develop Charcot's joint.
- The muscles
lose their ability to support the foot correctly. As a result
of this, minor trauma (eg sprains; stress fractures) to the foot
go undetected and do not get treated. This leads to a slackness
of the ligaments (laxity), joints being dislocated, bone and cartilage
being damaged and deformity to the foot.
- The first
sign is a warm, red, swollen foot without pain or very little.
A x-ray may show broken or eroded bones, or joints that are separated.
Later, "rocker-bottom foot" develops: The bones and
joints collapse and the arch of you foot disappears. Over time,
the broken and degenerated bones fuse together and the foot tries
to heal itself. By this time, the inflammation has generally calmed
- In most
cases only one foot is affected, but both feet can be affected
- If treated
early a 'total contact cast' worn for 3 - 4 months will prevent
you from injuring your foot further. If you develop the rocker-bottom
foot, your mid-sole will be bearing most of your weight.
can you do to protect you feet on a daily basis?
is the leading cause (accounting for 50%) of all non-accident-related
amputations. Research has demonstrated that over 80% of foot ulcers
and amputations are preventable by educating people about proper
foot care and footwear.
- Wear shoes
and socks (allowing the foot to breathe) at all times, even indoors,
to prevent injury.
- Wear shoes
that fit well (roomy but not sloppy).
- Always check
the insides of your shoes for foreign debris before putting them
- Make sure
that the lining is smooth and there are no foreign objects in
the shoe, such as pebbles.
your feet from hot and cold temperatures.
- Put your
feet up when you are sitting. Wiggle your toes for 5 minutes,
2 or 3 times a day. Move your ankles up and down and in and out
to improve blood flow in your feet and legs.
- DO NOT cross
your legs for long periods of time.
- DO NOT wear
tight socks, elastic, or rubber bands, or garters around your
- Keep your
skin soft and smooth and trim toenails straight across.
- Bathe (don't
soak) your feet daily in luke-warm water using a mild soap and
- Make daily
foot checks a routine.
- Have a professional
take care of your nails and skin if you cannot see well.
- Be sure
to call your doctor immediately if a cut, sore, blister or bruise
on your foot does not heal after one day.
can a pedorthist help to treat it?
and footwear play an important role in foot care for persons affected
by diabetes to help prevent serious injury and help an injury
used for orthotics:
on the history of complications such as ulceration and the presence
or absence of sensation on the foot:
- No history
of complication and has normal sensation should have an orthotic
that will accommodate any abnormal mechanics to alleviate abnormal
pressures on the foot.
- With an
ulcer and no sensation requires an orthotic that will redistribute
pressure away from the ulcer site and allow it to heal. Plastazote
is the most common material designed to accommodate pressure "hot
spots" by conforming to heat and pressure to protect the
should have the following features:
should have toe box that is shaped like the foot and is deep enough
to protect the toes from excessive pressure;
insoles are preferred for versatility in fitting, as they can
be removed to insert an orthotic if necessary, or modified themselves
to relieve pressure;
- Rocker soles
on the shoes help to reduce pressure in the ball of the foot,
an area that is susceptible to pressure sores/ulcers;
- Firm Heel
Counters are recommended for support and stability.
pain in the "ball of your foot," that area between
your arch and the toes, is generally called metatarsalgia
(met'-a-tar-sal'-gee-a). It's a non-specific diagnosis of
pain in and about the Metatarsal (MT) head or MTP (Metatarsal/Phalangeal)
joint and adjacent soft tissue structures.
Morton's foot (long 2nd
metatarsal), Freiberg's Disease
(usually 2nd metatarsal head osteochondritis in
young women), Metatarsal stress fractures
(hair-line cracks that arise in bone as
the result of repeated low-level forces), sesamoiditis
(gradual onset of and increasing pain at the plantar
aspect of the medial plantar border of the 1st MPJt
(metatarsal phalangeal joint) with swelling and decreased
ROM (range of motion), Morton's neuromas
(usually in heavier women, where the lateral and
medial plantar nerves get compressed in the 3rd interdigital
space), ganglionic cysts
(weak wall of a synovial tendon sheath or jt. capsule), joint
capsulitis (frequently secondary to OA (osteoarthritis)
and RA(rheumatoid arthritis) or ongoing low-grade Jt. trauma),
synovitis (common in RA),
flexor tenosynovitis, rheumatoid bursae and nodules
(those with RA tend to be very large over the bunion and plantar
aspect of MPJts., and fibrinoid nodules over bony prominences),
bursitis (shearing of
bursa may cause it to become fibrous, distended, inflamed,
infected or even calcified), transient
ischaemia (nerve and artery serving the affected
nerve are compressed during gait by the distal distension
of the intermetatarsal bursa), gouty
tophus (1st MPJt.
Uric acid crystal-idposition), myalgia,
neoplastic disease (rare tumours) ,
plantar plate rupture (from hyperextension @ 1st-
turf toe) (tough, rectangular, fibrocartilaginous structure
that overlies the plantar aspects of the MPJts), and focal
hyperkeratosis (deep seated corns)
Morton's Neuroma Site
Posterior tibialis tendonitis is an inflammation of the tendon
that runs along the inside of the ankle and attaches to the middle
of the foot along the inside edge.
The posterior tibial tendon helps hold your arch up and provides
support as you step off on your toes when walking. If this tendon
becomes inflamed, over-stretched or torn, you may experience pain
on the inner ankle and gradually lose the inner arch on the bottom
of your foot, leading to flatfoot.
Inflammation may be caused by biomechanical factors such as abnormal
pronation that repetitively stretches this muscle and tendon. It
can also result from being overweight, or from previous trauma,
inflammatory diseases such as rheumatoid arthritis, Reiter's syndrome
or psoriatic arthritis. Excessive repetitive force such as running
on a banked track or road can also cause the inflammation.
Medial Tibial Stress Syndrome includes tendonitis and periosteal
irritation involving the posterior tibial muscle and tendon, the
flexor muscles and tendons, and other soft tissues attached to the
posteromedial border of the tibia. If left untreated this has an
increased risk of turning into a stress reaction and stress fracture.
Shin splints can be caused when the anterior leg muscles are stressed
by running, especially on hard surfaces or extensively on the toes,
or by sports that involve jumping. Wearing athletic shoes that are
worn out or don't have enough shock absorption can also cause this
It is important not to try to train through the pain of shin splints.
Runners should decrease mileage for about a week and avoid hills
or hard surfaces. If a muscle imbalance, poor running form or flat
feet are causing the problem, a long-term solution might involve
a stretching and strengthening program and orthotics that support
the foot and correct over-pronation. In more severe cases, ice massage,
electrostimuli, heat treatments and ultra-sound might be used.