These can be either Acute (Direct impact injury) or Overuse (as a result of long standing problems or repeated trauma or stress to the area). Many sports injuries can be avoided or treated with proper stretching. See our page on stretching for some exercise regimes that may be prescribed by your podiatrist.
Overuse Injuries – Bone
A Stress Fracture is a micro fracture in bone that results from repetitive physical loading. Changes occur within the bone, which can result in a complete fracture occurring if the area is not rested appropriately. Stress fractures are generally diagnosed via a bone scan, MRI or X-ray. Stress fractures can occur in any bones in the bony. The most common are the tibia (shin bone), metatarsals (toes), fibula (smaller shin bone), tarsal (midfoot), navicular (bone in midfoot), femur (thigh bone) and pelvis. Pain is usually localised and tender over the fracture site. There may be pain at night, pain on standing, hopping and usually pain is greatest during activity i.e. running.
Or stress reaction is an area on bone that does not show a stress fracture, but does indicate an area of concern in diagnosis (bone scan). This may be the start of a stress fracture and may well develop into a stress fracture if left untreated.
Inflammation at the tendon’s attachment to bone. This occurs commonly in sports and is most common on the inside of the shin bone. Commonly called ‘shin splints’.
Bony inflammation and separation may occur at the attachment of tendons to the growth plates on certain bones. In particular the attachment of the large patella tendon to the upper shin bone (tibia) causing below knee pain and the attachment of the Achilles tendon (calf tendon) to the calcaneus (heel bone) causing heel pain. (Osgood Schlatter and Sever’s disease) are common in young athletes (see particular information sheets for more detailed information).
Inflammatory changes in joints associated with overuse are not uncommon in athletes. These are classified as Synovitis (inflammation of the synovium (joint fluid) and capsulitis (inflammation of the joint capsule)
Arthritis may also cause associated problems. Note: chronic inflammation of joints may lead to degenerative change and subsequently lead to osteoarthritis.
Overuse injuries involving ligaments are not common in athletes. The main injuries are more acute type sprains.
Repeated trauma to a muscle/s leads to an inflammation and then thickening within the muscle (fibrosis). These thickenings can lead to pain or predispose other structures, such as tendons to injury because the thickened muscle is unable to stretch to its normal length during activity.
Chronic Compartment Syndrome
The muscles in the lower leg are divided into a number of compartments by fascial sheaths (like inelastic gladwrap covering). As we exercise the pressure in these compartments increases. This causes swelling of the leg and an accumulation of fluid in the fascia. The fascia is inelastic and therefore prevents expansion. This then impairs blood supply to the area and causes pain when exercising. A vicious cycle may then occur.
These are the most common overuse injuries in the lower leg. Tendons are complex structures made up of collagen bundles, which transmit forces from muscle to bone. They are therefore subject to great stress and strain. The blood supply to tendons differs due to the particular tendon’s covering. A tendon which pulls in a straight line (e.g. Achilles tendon) is covered in a paratendon, which has its own bloody supply.
A tendon that moves around a bone (e.g. peroneus longus) has a sheath that is not supplied with blood.
A tendon’s blood supply is compromised when there is friction, torsion (twisting) or compression of the area. This will affect healing of the tendon after injury. Tendon injuries can occur at any part along the tendon (muscle belly, muscle-tendon junction, insertion to bone).
There are a few different names given to tendon injuries:
Occurs at common sites in the lower leg are the tibialis posterior and flexor hallucis longus tendons.
Common symptoms are:
• Pain after exercise or the next morning
• There may be pain at rest
• You may feel that you can ‘run through’ the pain or the pain may decrease with ‘warm-up’ and returns after cool down.
It is important to know that athletes who continue to train through the pain are injuring the tendon repeatedly and interfering with the healing process. This also makes it more difficult for the clinician to help you.
Tendinosis often takes a long time to resolve and patience is important in recovery.
Is the inflammation of the tendon. This may occur in association with inflammation of the paratendon (paratendonitis).
This includes terms such as peritendinitis and tenosynovitis. This is particularly likely to occur at sites where the tendon rubs over a bony prominence and directly irritates the paratendon (tendon surrounding tendon)
The body contains many bursae that lie between bony surfaces and overlying tendons. Their job is to help the tendon move over a bony surface. Injuries after repeated stress to the bursa are common in the retrocalcaneal (back of heel bone) under the Achilles tendon. It is usually swollen and painful at the site on specific movements.
Nerve entrapment syndromes occur in athletes as a result of swelling in the surrounding sift tissues or abnormal anatomy. This may occur in the medial ankle and between the digits (Mortons neuroma). Symptoms are using radiating pain, sharp shooting pain, numbness or tingling.
Blisters may occur at any site of friction due to footwear, sporting equipment or socks. These can occur because the shoe is too tight, or new. These can be prevented and can be discussed with your Podiatrist in detail.