shin_splints

The condition known as Shin Splints involves a muscular over-use scenario. There are Anterior Shin Splints and Posterior Shin Splints. Anterior Shin Splints involve the Tibialis anterior muscle of the anterior compartment of the leg, and Posterior Shin Splints involve the Tibialis posterior muscle of the posterior compartment of the leg.

Both of these muscles are involved in slowing down pronation during the stance phase of gait. Tibialis anterior functions early in the stance while Tibialis posterior functions a little later. If the patient over-pronates or pronates too rapidly, either or both of these muscles may be called upon to work harder than normal. As a result, fatigue sets in, leading to inefficient force production which leads to micro-tearing of the soft tissue and therefore and inflammatory reaction. Since the muscle is wrapped in a fascial covering, the swelling that occurs from the aforementioned problem is restricted by this covering. Beyond the fact that much pain results from the entire process, the presuure within the fascial covering can be suffiecient to “choke-off” the blood supply to the involved musculature, further added to the insult on the tissue. In severe circumstances the swelling can be severe enough to damage the deep peroneal nerve resulting in a permanent “foot drop,” as this nerve supplies the dorsiflexors of the foot. The scenario that typically brings on “shin splints” is a sedentary individual that suddenly starts running or walking long distances. When that individual is also an over-pronator, the combination of having weak muscles from lack of activity and having this biomechanical fault increase the likelihood of injury. Even changing the type of shoe worn during walking or running can be sufficient to increase the pronation of the subtalar and transverse tarsal joints and lead to tissue injury.

sacroiliac_syndrome

Sacroilliac syndrome is a painful inflammatory condition of the sacroiliac joints. The patient generally experiences pain in the buttock and thigh regions. It is typically aggravated by sitting for long periods.

Quite frequently it is caused by an injury such as would be sustained by a fall on the buttocks or during a lifting activity. However, there is some evidence to suggest that a chronic irritation from abnormal foot mechanics is also a possible cause. When a foot over-pronates, it creates a tendancy towards internal rotation of the lower limb. Due to the anatomy of the hip joint, this internal rotation translates into an extension of the pelvis (PSIS’s rotate upward while ASIS’s rotate downward). If the mechanics of the feet are not symmetrical, then conflicting rotations may occur at the two sacroiliac joints. This appears to set up a chronic irritation of these joints leading to the inflammation.

runners_knee

Runner’s Knee is a general term referring to pain around the front of a runner’s knee.

If the pain is anteromedial in location, the source of the problem may be over-pronation. The internal rotation of the tibia associated with over-pronation, may cause the knee to fall into a functional valgus orientation during the stance phase of gait. This in turn will compromise the ligaments on the medial aspect of the knee. Furthermore, the abnormal motion will result in abnormal pressures behind the patella, leading to a more specific knee malady referred to as chondromalacia patella.

plantar_fasciitis

Plantar fasciitis is an inflammatory condition that occurs where the plantar fascia attaches to the medial tuberosity of the calcaneus.

Over-pronation results in a constant tugging of the aforementioned attachment site. Inflammation then results from this constant insult to the local tissues. When the patient is off-weight bearing, scar tissue begins to repair the site of injury. When the patient resumes weight-bearing, the scar tissue is torn resulting in acute pain. This explains why patients with this disorder typically experience the most pain when they get out of bed, or stand after a period of sitting.


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