Running Form

Icing an Injury


Hip Replacement Procedure

Achilles Tendon Tear


Knee Replacement Procedure

The term shin-splints is often incorrectly used to describe any pain in the leg between the knee and the ankle. The lower leg consists of three compartments, and which muscles are injured and causing the pain determines the proper treatment.
Shin-splints occur a few inches below the knee on the medial (inner) side of the leg. The pain is located in the posterior tibial muscle/tendon. This muscle starts below the knee on the tibia, wraps around the inside of the ankle, and attaches to the underside of the foot. This route causes a pulley-like action that generates considerable force at either end. If a person runs too much, or if the feet are not working correctly, the muscle can become overstretched and pull excessively at the point where it attaches to the tibia.

Iliotibial band syndrome is an injury that has been seen over the past few years with increasing frequency. It appears to be related to weak hip abductor muscles. Strengthening the hip abductors and stretching the ITB and structures that attach in to it are usually the keys to recovering from this problem.
Symptoms of the iliotibial band syndrome include pain or aching on the outer side of the knee. This usually happens in the middle or at the end of a run. A concomitant problem may occur at the hip called greater trochanteric bursitis. During flexion and extension of the knee the iliotibial band rubs over the femoral condyle which leads to irritation. Weak hip abductors, especially the gluteus medius is often found. Some other factors that may contribute to this syndrome include genu varum (bow legs), pronation of the foot (subtalar joint pronation), leg length discrepancy, and running on a crowned surface. We need to emphasize that over the past few years an association with weak gluteus medeus muscles has been found in many runners with ITB syndrome.
The function of the muscles inserting into the ITB (Tensor Fascia Lata) is to abduct the leg. If the hip abductors are weak, then the ITB is being overworked. The ITB does not have an insertion that offers a favorable mechanical advantage. In fact, it is at a considerable disadvantage for the purpose of hip and leg abduction activity. Therefore when the hip abductors are weak, the tensor fascia lata must contract harder and over a longer period of time thus straining the ITB. Make sure that part of your cure is to strengthen your hip and leg abductors.

Plantar fasciitis is the most frequently encountered cause of plantar heel pain. For many years pain in this region has been incorrectly termed the "heel spur syndrome". It would be better termed a "plantar heel pain syndrome". While heel spurs sound ominous, they can be present and not cause any pain. The formation of a spur is a sign that too much tension has developed within the plantar fascia, and it may have partly torn from its origin at the calcaneus (heel bone). This may result in new bone formation at the site of the injury.

Big-Toe Bunions
i. A bunion will usually require surgery. The surgery requires remodeling the first metatarsal phalangeal joint and forming a new joint by placing a medical-grade plastic joint or “spacer” in the great toes. It is necessary to form new grooves on the bottom of the first metatarsal heads for the small sesamoid bones, which are necessary to provide for power and spring.
ii. A bunion is called a “hallux valgus” with overlapping second toes. The great toes are bent toward the outside of the feet and the second toes lie on top of them. The bunion is the protrusion of bone on the inside of the foot at the big toe joint.
Stress Fractures
i. X-rays will reveal a small crack in the bone
ii. Stress fractures occur because of overuse. Result when causing too much stress on the body. The constant microtrauma during running can cause a crack in the bone.
iii. Stress fractures or relatively non-involved fractures of the metatarsal bones in the foot may be knitted enough within 3 weeks to allow for some activity if a good foot support is provided as well as proper taping.
Arch Injuries
i. Heel spur- pain more severe at heel contact.
ii. Plantar fasciitis- pain is more severe when running on the balls of feet.
iii. Medial nerve problem or stone bruise- heel contact causes pain.
Heel and Achilles
i. Runner’s Bump (on the heel)- a retrocalcaneal exostosis, a painful blister or bursa on the outside of the heel alongside where the achilles tendon attaches to the heel bone. As the heel bone rolls against the counter of the show, there is irritation, which causes first a blister, and later forms a bump as the body tries to protect the skin from further blistering. The bone then reacts to the pressure by forming more bone. Achilles tendon is stretched over the bone spur and there is irritation and inflammation.
ii. “Tenosynovitis” – the thickening of the sheath of the achilles tendon
iii. Surgery- At the incision the achilles tendon sheath was swollen and adherent to the underlying fatty tissue and the tendon itself. Abnormally thick tissue was excised and tight, constrictive tissue was released surgically. The achilles tendons were not damaged.
Ankle Sprains
i. Sprains are the most common ankle injury. Sprains are partial or complete tears or ruptures of ligaments. The sprain is the result of excessive normal motion.
ii. First-degree sprain- there is very little swelling or damage done to the ligaments. There is mostly just tenderness with pressure over the ligament or extreme fast running.
iii. Second-degree sprain- will have more tearing of the ligaments, often the anterior lateral colateral ligament. Athlete may walk with a mild limp, have discomfort rising off heels, and have pain when jumping on the balls of the feet.
iv. Third-degree sprain- limp and pain with walking. Treatment will usually consist of elevation, ice, and crutches, or the sprain may need a cast and taping.
v. Fourth-degree sprain- an unstable sprain in which the anterior lateral colateral ligament is completely ruptured. If the sprain is not treated properly it may lead to an unstable ankle which chronically gives out and arthritis or spurring in the front of the ankle.
vi. The best time for examination of a sprain is within the first twenty minutes after the injury occurred. During this time there is less spasm and swelling and one can feel and see the ligaments.
Shin Splints
i. A patient may be extremely tender in the lower one-third of the legs, to the inside of the shinbone. The feeling is in the posterior tibial muscle area.
Hip and Low Back
i. Problems may not always be helped by orthotics. Many patients with low-back pain are referred to an orthopedic surgeon because they have true pathology in the low back.
ii. Some lower-back pain may be due to limb-length discrepancy and overpronation of one foot or the other. Patients with problems such as these will use orthotics.