Chronic Peroneous Longus/Brevis pain

[Justus]

For the past nine months or so I have had pain on both feet that ranged from the inside-middle of my foot, diagonally across my ankle and up the outside of my calf about half-way. This appeared to fit with the location of the peroneous longus and brevis.

I am a snowboard instructor and have been experiencing the pain since last snowboard season. I have been snowboarding for several years and this past season was the first time that I experienced pain in this area. It has been at its worst during the season and directly after, but it hasn't completely subsided. I have been running more than usual lately and it is acting up again. The pain is usually worse on my left leg, but my right occasionally hurts as well.

I don't know if it has to do with the way I run or snowboard- even though I think I have a pretty normal foot pattern- or if it is something else. I don't have health insurance, so any advice about what it would be or methods to adjust my style of exercising (without giving up snowboarding) to make it feel better would be GREATLY appreciated.

Thanks.

Justus

[Heidi]

Hi

Peroneal injury is a possibility, however pain starting on the inside of the foot would be unusual.

The foot is a very complex area and so pain could be arising from a number of sources and may even be referring from elsewhere.

The first step I would advise is to get your feet and walking pattern checked by a professional to ensure that there is no excessive pronation or supination. If so the problem could easily be fixed with insoles or possibly different boots.

Good luck!

[extremeskins]

Hi Justus,

The muscle you are describing is Tibialis Anterior:

http://saveyourself.ca/resources/images/spot03.jpg

As a former snowboarder.... I can sympathesize. The Tibialis Anterior is the primary ankle dorsiflexor.... and the muscle that works overtime in snowboarding (to keep the front edge of the board up); the problem is.... the Tibialis Anterior is a phasic muscle (fast-twitch fibers) which tires easily until it is conditioned (through strength training) to handle the loads -- hence, gradual progression with strength training will be necessary.

And what you are describing (ie. symptoms and mechanism of injury) is consistent with "Medial Tibial Stress Syndrome" (ie. shin splints):

http://orthopedics.about.com/cs/sportsmedicine/a/shinsplint.htm

What are shin splints?
The term shin splints is a common misnomer in sports medicine. It does not imply a specific diagnosis, rather it is the symptom of pain over the front of the tibia bone. The pain from shin splints can be due to either problems of the muscles, the bone, or the attachment of the muscle to the bone. Therefore, 'shin splints' is simply the name given to pain over the front of the lower leg.

What causes shin splints?
The symptoms of shin splints can be caused by several conditions. These conditions include:

o Medial tibial stress syndrome (the most common cause of shin splints)
o Stress fractures
o Exercise induced compartment syndrome

Shin splints are most commonly due to overuse. When the overuse causes irritation to the tendons and the attachment of these tendons to the bone, the condition is called medial tibial stress syndrome. This is what most people are talking about when they use the words shin splints as a diagnosis.

Medial tibial stress syndrome, or shin splints as most people call this problem, is commonly seen in athletes who suddenly increase their duration or intensity of training. This type of shin splints may also be seen in athletes who have very high demand training levels, such as marathon runners, even if their training levels are not dramatically increased.

Why are some people more susceptible to shin splints?
Everyone has a different body, and each persons body mechanics differ slightly. One factor commonly implicated in causing shin splints is overpronation. Pronation occurs when the foot flattens out when weight is applied. The normal foot should flatten slightly, meaning pronation is a normal foot motion. Overpronation occurs when the foot becomes too flattened out causing the foot to roll inwards. This can cause increased demand on the muscle over the front of the leg and lead to complaints of shin splints.

How is the cause of shin splints determined?
As mentioned previously, the term shin splints is not actually a diagnosis, but a group of problems that causes a typical pain. Therefore, your doctor with perform a careful medical history and physical examination to determine the cause of the shin splints. The area of maximal tenderness may be different in patient who have different underlying problems causing shin splints. There are also provocative tests that can help determine the cause of the shin splints.

Patients with medial tibial stress syndrome typically have a dull, aching type of pain on the inside of their tibia bone. On examination, patients with medial tibial stress syndrome will often be tender over this same part of the tibia. Patients may or may not have a small amount of detectible swelling over this part of the tibia. Some specific maneuvers, especially resisted plantar flexion (pushing down of the foot against resistance), typically causes an increase of symptoms.

In order to determine the underlying cause of the shin splints your physician may order an x-ray or a bone scan. The x-ray can detect fractures, and occasionally detect long-standing stress fractures. The bone scan will detect areas of high bone turnover; these ‘hot’ areas indicate possible stress fractures or other bone problems. Patients with medial tibial stress syndrome may also have an abnormal bone scan, but there is usually a difference that can be detected to differentiate medial tibial stress syndrome and stress fractures.

What is the treatment for shin splints?
Use the following general treatment guidelines if you are diagnosed with shin splints. It is important to note that the treatment of a stress fracture is not the same, and persistent shin pain should be evaluated by your doctor before you begin treatment.

* Apply ice packs or perform ice massage for up to 20 minutes, three times a day.

* Take an anti-inflammatory medication prescribed by your doctor.

* If you have a foot that excessively pronates, consider special footwear or orthotics.

* Perform rehabilitation exercises (low-impact) regularly. Swimming and cycling are excellent activities for an individual with shin splints. Try to avoid excessive impact while recovering.

How can I prevent shin splints?
Prevention is best accomplished with smart training. If your sport involves high impact activities, make sure you have days that are low-impact (e.g. cycling or swimming) and no running. Increase the intensity and duration of exercise gradually. When you are increasing your activity, perform more low-impact exercise in the beginning. Make sure you have proper footwear that has been replaced regularly (life span of most running shoes is about 500 miles or 6 months). If you can run on grass or trails for some of your training (rather than pavement) that will also help prevent shin splints.

[extremeskins]

Look up exercises for the following muscles:

1. Extensor Digitorum Longus
2. Extensor Hallicus Longus
3. Tibialis Anterior

You should be able to find exercises that you will be able to perform rather easily.

And if you can afford to.... see a chiropractor or massage therapist that can perform Active Release Techniques (A.R.T) -- it will help you IMMEDIATELY and in the long run as well.