Leg Pain

Overview

This is a common injury, affecting the anterior (front) compartment of the lower leg- the shin. Anyone can be affected, but it is more common in people who engage in running, sports or increased activities. Whilst colloquially referred to as shin splints, the more accurate term is MTSS- medial tibial stress syndrome.

Shin splints are characterised by pain in the lower part of the leg, the lower 2/3rds, between the knee and the ankle. This pain generally increases with increased duration of intensity of running and jumping activities, and ends when the exercise stops or can decrease as you warm up. Injuries are caused by repeated trauma to the connective muscle tissue surrounding the shin, however there is not normally a single traumatic event involved. Ignoring this injury may result in a more serious condition such as a stress fracture of the bones or compartment syndrome.

Symptoms include:

• Pain, palpable tenderness, swelling and a recurring dull ache
• History of prolonged activity or exercise after a period of inactivity.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

• Thorough history
• Strength and range of motion testing
• Biomechanical and gait assessment
• Evaluation of work, leisure activities and training programs that may exacerbate the condition
• Evaluation of footwear
• Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.) especially if there are concerns of a stress fracture.

Treatment

Treatments for shin splints include:

• Anti-inflammatory medication
• RICE – Rest (a couple of weeks or up to three months for severe cases), Ice, Compression, Elevation
• Decrease duration or intensity of exercise and build it up slowly, as well as exercise caution on high impact surfaces, until the muscles re-condition
• Physical therapy modalities such as ultrasound, extracorporeal shock wave therapy, whirlpool baths, phonophoresis, augmented soft tissue mobilisation, electrical stimulation
• Stretching and strengthening exercises
• Injection therapies such as acupuncture, prolotherapy and cortisone
• Footwear with sufficient shock-absorbing soles
• Orthotics to control biomechanical problems such as pronation.

Overview

Compartment syndrome, a buildup of pressure within the tissue of the foot, is a painful condition that can result in tissue damage. Potential causes are injury (acute compartment syndrome) or exercise (exertional compartment syndrome).

When compartment syndrome occurs following an injury, immediate surgery is required to prevent damage to the nerves, blood vessels and muscles of the foot.

Exercise-induced compartment syndrome is a chronic condition and is usually not a medical emergency. It commonly occurs in seasoned athletes who perform repetitive motions while running, bicycling and swimming. Symptoms include aching, burning or cramping and can be confused with shin splints. The symptoms are usually relieved by discontinuing the exercise.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

• Thorough history
• Strength and range of motion testing
• Biomechanical and gait assessment
• Evaluation of work, leisure activities and training programs that may exacerbate the condition
• Evaluation of footwear
• Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

If you have acute compartment syndrome, you will need to reduce the pressure on the arm or leg. If you have a bandage or plaster on, it will need to be removed. You will also be asked to have your limb up in the air.

If that doesn’t ease pain straight away, you will need surgery to cut into the muscle compartment and ease the pressure.

If you have chronic compartment syndrome, resting will help. That is often enough for the condition to settle. You might also be advised to switch to low-impact exercise.

Overview

A muscle strain is an injury to a muscle or a tendon. Minor injuries may only overstretch a muscle or tendon, while more severe injuries may involve partial or complete tears in these tissues.

Signs and symptoms will vary however may include:

• Pain or tenderness
• Redness or bruising
• Limited motion
• Muscle spasms
• Swelling
• Muscle weakness

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

• Thorough history
• Strength and range of motion testing
• Biomechanical and gait assessment
• Evaluation of work, leisure activities and training programs that may exacerbate the condition
• Evaluation of footwear
• Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Initial treatment includes rest, ice, compression and elevation. Mild strains can be successfully treated at home and in conjunction with your podiatrist or physiotherapist. Severe strains sometimes require surgical repair.

Overview

The leg contains superficial veins, close to the surface, and deep veins, which lie much deeper in the leg. Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a deep vein and most of these clots commonly occur in the veins of the leg in either the calf or thigh.

DVT can be very dangerous and is considered a medical emergency. If the clot breaks loose and travels through the bloodstream, it can lodge in the lung becoming a pulmonary embolism, and can make it difficult to breathe and may even cause death. Blood clots in the thigh are more likely to cause a pulmonary embolism than those in the calf.

Many factors can contribute to the formation of a DVT. The more risk factors a person has, the greater the risk of having a DVT. However, even people without these risk factors can form a DVT.

Risk factors to developing a DVT include:

• Previous DVT
• Varicose veins
• Blood clotting disorders
• Family history of DVT or blood clotting disorders
• Heart disease
• Chronic swelling of the legs
• Obesity
• Inflammatory bowel disease
• Cancer
• Dehydration
• Sepsis
• Hormone replacement therapy
• Birth control pills containing estrogen
• Pregnancy or recent childbirth
• Age over 40 years old
• Immobility (through inactivity or from wearing a cast)
• Recent surgery
• Trauma (an injury)
• Smoking

Some people with DVT in the leg have either no warning signs at all or very vague symptoms. If any of the following warning signs or symptoms are present, it is important to see a doctor for evaluation:

• Swelling in the leg
• Pain in the calf or thigh
• Warmth and redness of the leg

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

• Thorough history
• Strength and range of motion testing
• Biomechanical and gait assessment
• Evaluation of work, leisure activities and training programs that may exacerbate the condition
• Evaluation of footwear
• Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

If tests indicate a clot is present, the doctor will make a recommendation regarding treatment. Depending on the location of the clot, the patient may need hospitalization. Medical or surgical care will be managed by a team of physicians, which may include a primary care physician, internist, vascular (blood vessel) surgeon or hematologist (blood disease specialist).

Treatment may include:

• Medication. A blood-thinning medication is usually prescribed to help prevent additional clots from forming.
• Compression stockings. Wearing fitted hosiery decreases pain and swelling.
• Surgery. A surgical procedure performed by a vascular specialist may be required.

An early and extremely serious complication of DVT is a pulmonary embolism. A pulmonary embolism develops if the clot breaks loose and travels to the lung. Symptoms of a pulmonary embolism include:

• Shortness of breath
• Chest pain
• Coughing up blood
• A feeling of impending doom

A long-term consequence of DVT is damage to the vein from the clot. This damage often results in persistent swelling, pain and discoloration of the leg.

For those who have risk factors for DVT, these strategies may reduce the likelihood of developing a blood clot:

• Take blood-thinning medication, if prescribed.
• Reduce risk factors that can be changed. For example, stop smoking and lose excess weight.
• During periods of prolonged immobility, such as on long trips:
  • Exercise legs every two to three hours to get the blood flowing back to the heart. Walk up and down the aisle of a plane or train, rotate ankles while sitting and take regular breaks on road trips.
  • Stay hydrated by drinking plenty of fluids; avoid alcohol and caffeine.
  • Consider wearing compression stockings.