Shin and foot pain
History
An 11 years old female, national gymnast for NSW, has been going to physiotherapy for several weeks as a result of calf tightness and foot pain. She has not yet had any scans.
Her short terms goals are to be able to keep training in preparation for nationals with minimal pain, and to compete at nationals. Her long term goal is to be able to train with no pain in her feet.
She had an initial gym assessment 2 months ago, where she was found to have a Beighton hypermobility score of 1 (she can touch palms to ground), a knee-to-wall test of 8cm bilaterally (desirable 10cm), she can perform more than 20 single leg calf raises bilaterally, she has bilateral decreased FHL ROM (Thomasen’s sign), and bilateral tight rectus femoris and TFL on the Thomas test. She also has a history of shin and ankle pain.
Clinical examination
In May she presented with bilateral pain with single leg hopping, decreased dorsiflexion, bilateral tightness of calves, and pain around tibialis anterior and tibialis posterior.
The provisional diagnosis was navicular stress fracture, hair-line fracture, bony bruising, tibialis posterior strain, tibialis anterior strain, tendinopathy of tibialis posterior or tibialis anterior, plantar fasciatiis, spur, ankle sprain, anterior compartment syndrome, posterior compartment syndrome, patella-femoral pain syndrome, or tibialis posterior dysfunction. The MRI showed no stress fracture, normal bones, no ligament or ganglion abnormalities, normal tendons, no soft tissue injury L = R, and no abnormality seen that could account for pain. After ruling out knee, hip and back as origin of the pain, the problem was identified as coming from the ankle area: she had an exertional compartment syndrome associated with a plantar fasciitis.
Management
Her treatment consisted on education about her condition, and advice to modify activity that increases shin pain. She was advised to apply ice daily to reduce swelling, and recommended to take NSAIDs to reduce inflammation.
Soft tissue release technique and plantar fascia stretching improved her symptoms. A low dye taping with a modified reverse 6 was applied to alter navicular height and plantar pressures. This provided arch support and prevented excessive pronation, which relieved her symptoms.
Her pain gradually subsided and she was able to return to gymnastics after week. She was advised to perform plantar fascia stretching before training.
If you have any questions regarding shin or foot pain, and need an assessment, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.