I treat a number of patients who complain about pain in the lower leg or foot. While some are just sore after their extended marathon training, some present symptoms that may make participation in a marathon questionable.
Inflammation of the lining that connects muscle to bone in the lower leg, “shin splints,” is a common complaint of runners – particularly those who have fallen behind in training and try to catch up and suddenly increase distance or speed.
Shin splints are an inflammation of the muscles, tendons, and bone tissue around your tibia. Pain typically occurs along the inner border of the tibia, where muscles attach to the bone.
Shin splint pain most often occurs on the inside edge of your shinbone.
(Reproduced and adapted with permission from Gruel CR: Lower Leg, in Sullivan JA, Anderson SJ (eds): Care of the Young Athlete. Rosemont, IL, American Academy of Orthopaedic Surgeon, 2000.)
While painful and annoying, shin splints usually respond well to conservative measures such as ice, massage and rest. The following treatment often provides relief from pain:
Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen, aspirin, and naproxen reduce pain and swelling.
Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
Flexibility exercises. Stretching your lower leg muscles may make your shins feel better.
Supportive shoes. Wearing shoes with good cushioning during daily activities will help reduce stress in your shins.
Orthotics. People who have flat feet or recurrent problems with shin splints may benefit from orthotics. Shoe inserts can help align and stabilize your foot and ankle, taking stress off of your lower leg. Orthotics can be custom-made for your foot, or purchased “off the shelf.”
Before returning to exercise, you should be pain-free for at least two weeks. Keep in mind when returning to exercise that it must be at a lower level of intensity. It is important to warm up and stretch adequately. If you’re scheduled to run a marathon and an injury occurs too close to your race date, you must make a decision about whether or not to participate based on the level and duration of pain.
In addition to shin splints, distance athletes like marathoners are at-risk for stress fractures of the foot and lower extremities. The repetitive pounding involved in training for and participating in a marathon is sometimes too great a force for the bony skeleton. Runners will present to the office complaining of a sudden onset of pain with running or sometimes with a story of insidious soreness followed by significant pain with weight-bearing.
Pain with activity is the most common complaint with a stress fracture. This pain subsides with rest. X-rays are commonly used to determine a stress fracture. Sometimes, the stress fracture cannot be seen on a regular x-ray or will not show up for several weeks after the pain starts. In the case of individuals training for a race, an MRI is often ordered to document the injury so that guidance can be given on whether or not the patient can continue to participate.
The most important treatment is rest – avoiding running and jumping activities. If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. A rigid-soled orthopaedic sandal or walking boot helps to protect the bone as it heals over 6-8 weeks.
The following are tips developed by the American Academy of Orthopaedic Surgeons to help prevent stress fractures:
- When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.
- Cross-training — alternating activities that accomplish the same fitness goals can help to prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility exercises to the mix for the most benefit.
- Maintain a healthy diet. Make sure you incorporate calcium- and Vitamin D-rich foods in your meals. Use the proper equipment. Do not wear old or worn running shoes.
- If pain persists, see an orthopaedic surgeon.
- It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.
Gregory Caronis, M.D. is a partner of Greenleaf Orthopaedic Associates, a community orthopaedic practice serving Lake County for over 50 years. Dr. Caronis practices general orthopaedics and is a specialist in injuries to the foot and ankle and fracture care.