Achilles Tendinitis, Musculo-skeletal podiatry, Plantar Fasciitis

Running in Lockdown

During lockdown running has taken off due to its minimal requirement for equipment and can be done by all levels of runners.  If you have just started jogging or running it may be uncomfortable, but it should never be painful. Here are some common running conditions and how to manage them effectively at home.

Shin splints

“Shin splints” are also known as medial tibial stress syndrome (MTSS) which is an umbrella term for lower leg pain that occurs below the knee, either on the front outer part of your leg or the inside of your leg.

Shin splints happen when there are small tears in the muscles around your shinbones.  It may feel like a tight aching pain that fades after a warmup or after you stop working out.  It can feel painful and tender to the touch.  Shin splints are common among new runners and those returning after a long break, and after building up mileage too quickly.  Overpronation, inadequate stretching and wearing worn-out running shoes can also lead to shin splints.

When you feel the first twinges of pain, rest, then slowly get back into working out.  If the pain continues through the end of your run and radiates over a large area, it could be a stress fracture; see a podiatrist for further advice.  The easiest and best way to avoid shin splints is to increase mileage gradually, run on soft surfaces as much as possible, and make sure your shoes fit comfortably.

Home treatments include rest, icing after exercise, appropriate footwear or arch supports, and changing your running surface.  We can help with strapping.

Runner’s Knee

Patellofemoral pain syndrome (PFPS) or “runner’s knee,” is the irritation of the cartilage underneath the kneecap.  It can flare up during a workout or while going downhill and stairs. It is often caused by weak quadraceps, hips, or gluteal muscles, all of which can lead to overpronation and cause poor tracking of the knee.  Running with too much forward lean can also contribute to the problem.  You may feel twinges early in the workout that go away and then reappear.  As it worsens, the pain may be on the inside or outside of the knee and may continue even after you have finished your workout.

Take at least three days of rest until you are pain-free.  Avoid downhills or leaning too far forward during your workouts, as this can put more stress on your knees.  And strengthen your quads!  PFPS usually flares up during or after long runs, after extended periods of sitting, or while descending hills and stairs, so you may find uphill running is less painful.

Achilles Tendonitis

This condition is the tightening and irritation of the Achilles tendon, which connects the two calf muscles to the back of the heel.  It may start as a dull ache.  As it progresses, it may hurt to stand on tip toes, and you may develop severe pain and swelling.  It can be caused by doing too much too soon, doing too many hills, or wearing the wrong shoes.

If symptoms become worse, rest for a few days.  If you try to run through this, it may take months to go away.  Avoid aggressive calf stretching and wearing flip-flops and high heels, all of which can irritate the Achilles.

Start trying to strengthen the calves with eccentric heel drops: stand with the balls of your feet on a step.  Rise up on both feet.  Once up, take your stronger foot off the step.  Lower down on your injured foot, dropping your heel below the step.  Rise back up, return your other foot to the step.  Do 20 repeats.

Plantar Fasciitis

This is inflammation of the plantar fascia (PF) which extends from the heel to the toes.  It feels like a dull ache or bruise along the arch or on the bottom of the heel and it can be most painful first thing in the morning and at the beginning of a workout.  Overpronation and wearing worn-out shoes are the most common causes of PF.  A sudden increase in hill running or running on the forefoot can also set it off, as can long periods of standing.  Those with high arches are more at risk for PF, and it is often made worse if you wear shoes with no arch support or often walk around barefoot.

Avoid wearing flip-flops or open-backed shoes that offer no heel support. Stretch your calves and strengthen your glutes, both of which can help reduce  overpronation.

Recovery time can range from three months to a year, but six months is fairly typical.  In chronic cases, a complete break from running is usually best.  Cycling or swimming can help you maintain fitness, but only if you can do those activities without pain.  Strapping of wearing an Orthosleeve® sock will help support the arch and take the strain off the plantar fascia. 

Rolling your foot over a frozen water bottle for five minutes at a time can help.

Make sure your running shoes fit your foot type by having your gait analyses.  Stretch and massage the plantar fascia several times a day.

To stretch your plantar fascia, sit with one leg crossed over the other so that your ankle rests on the opposite knee. Grab the end of your supported foot at the toes and gently pull back.

Stress Fracture

Unlike an acute fracture that happens as the result of a fall, stress fractures develop from cumulative strain on the bone.  They most often occur in the foot or in the shins.  The symptoms may begin as minor pain and get worse as you run.  If left untreated, it may become uncomfortable even when just standing.  Stress fractures can result from overtraining, overstriding, and excessive impact.  If you increase the duration, intensity, or frequency of your workouts before your body is ready, your bones cannot repair themselves fast enough to keep up with the forces on them.  Stress fractures are more common in women than in men, usually due to nutritional deficits, low oestrogen levels, and inadequate calorie intake.

What to do: Stop all impact exercise and see a doctor right away for a bone scan.  The amount of rest you will need depends on the severity of the fracture and its location.  If you ran through the pain for a while before you realized you had a fracture, your recovery could take longer.  Try swimming and pool running as safe alternatives while you rehabilitate.

How your podiatrist can help

Taping

Taping is a temporary technique which is used as a protective mechanism in the presence of an existing injury. Some of the goals with taping are to restrict the movement of injured joints soft tissue compression to reduce swelling, support anatomical and as protection from re-injury. 

We use taping to 

  • Relieve your pain
  • Improve joint stability
  • Prevent injury
  • Correct faulty biomechanics
  • Inhibit muscle or tendon action

We usually couple taping with a range of exercises to enhance the healing process and to try preventing re-injury. 

Extracorporeal shockwave therapy

Extracorporeal shockwave therapy is a non-invasive and effective treatment for patients suffering from long standing injuries or musculoskeletal conditions. This treatment uses either radial or focussed shockwaves to the injured area which breaks down injured tissue and calcification. Strenuous exercise should be avoided for 2-3 days after administration and taping is often used to help enhance the healing process. 

Low Level Laser Therapy 

Low level laser therapy is a painless tool to be used to help certain musculoskeletal conditions. Low level laser therapy treatment can reduce inflammation, pain and help accelerate tissue regeneration. It does this by increasing oxygen blood flow, promoting muscle calcium uptake and increasing neurotransmitter release. 

Orthoses

Foot orthoses are devices which are worn in shoe which provide control for the foot and improve muscle function.  Orthoses can be customised or “off the shelf”.  “Off the shelf” orthoses may well provide sufficient control to improve the functionality of the feet, however may not perfectly fit to the patient and their feet. Customised orthoses are moulded and measured exactly to the specific patient and their feet which will give the optimal control and functionality.  Orthotic therapy is usually combined with exercises to strengthen the relevant muscles.

Exercises

Your podiatrist will be looking to help you rehabilitate after injury as quickly as is safely achievable and your rehabilitation plan will be staged to firstly heal the injured area and then bring it back to full function.  

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