Shin pain caused by orthotics !

Hi,

Back in July last year as part of treatment for a hip pain issue it was suggested I try orthotics, which I then had custom made by a podiatrist. They didn't help with the hip, which was later diagnosed as a SI & piriformis problem, due to the fact that I cycle a lot. But after 2 months of wearing the orthotics with no problems I started getting severe shin spasms which stared around about the outside of my knee and shot down the outer side of my shins.

I had the podiatrist change the orthotics a number of times, and the spasms ceased but now I have severe pain in the upper outside of my shin, and also the lower outside of the shin, near the shin bone. Eventually after a few more consultations and visits we decided to get ride of the orthotics, then get my physio, who is very good, to fix the problem.

Prior to going to the physio the problem was diagnosed as compartment syndrome and separately as Medial Tibial Pain Syndrome, but as the symptoms don't fit into either category it hasn't been easy to fix. Currently the physio has noticed that the joint just below the outside of my knee is very tight, as is the equivalent down by the ankle, and releasing those does ease the problem. To make it more complex if I compress the shin it makes it worse as does driving or walking, although cycling is fine.

Any suggestions that would help me get this long running issue resolved would be much appreciated.

Mark

Rigid orthotics can sometimes cause stress fractures up the fibula so if your problem just keeps getting worse the get a bone scan or X ray to exclude this.

Physio should continue to mobilise the proximal tibiofibula joint and also your subtalar joint. These joints work in together as a shock absorbing mechanism when you are running. Strangely enough sometimes the ankle joint can be causing this kind of pain so you should includ some stretches for this as well.

You may be OK with more flexible orthotics.

Dont forget to keep up with any stretches and strengthening for your SIJ and piriformis.

Good luck:)

Hi,

Thanks for that, stress fracture was ruled out as the pain goes when I exercise and comes on post-excercise or if I am sitting around too long, but I will ask physio if we can use X-ray just to eliminate.

To be honest after this I have been put off orthotics for life, so will continue with the treatment, stretching etc.


Cheers
Mark

Hi,

Can I ask a couple of other related questions :

- Compression seems to aggravate the shin it tightens up and feels like it will spasm again, does that make sense ?
- If the joints are the cause what length of time would you expect for recovery ?, as I have a mountain bike event to train for. I realise there are many factors so any estimate would be much appreciated!
- Finally has anyone seen this type of injury cause by an orthotic before ?

Thanks in advance
Mark

get your physio to look for trigger points (tight spots in muscles) around the front/outer aspect of your hip (glute med/min, tensor fascia lata) and down along the outside of your thigh and into the outside of your knee (vastus lateralis/itb). these can often be the cause of the symptoms you describe. your pain should be reproduced on proper skilled palpation of these particular areas (if this is the problem!)

if these seem to be contributing maybe you have some issues with imbalance around yur hip still that havent been fully addressed and are leading to this myofascial type pain referral. i would work on hip rom and dynamic control along with myofascial work/trigger point release/dry needling etc as needed.