Naughty Feet, Shin Splints

When I was four-and-a-half, I went to ballet classes at Gamlingay Church Hall. If you've never donned a tutu before, 'Good Toes' means having your feet in a '10 to 2' position with the backs of your knees touching. It wasn't easy, and when combined with flapping hankies, running around on our tippy toes, and pretending to be delicate Chinese ladies with fans, my commitment began to wane. When Saturday Swap Shop started with Noel Edmonds (who was a bit of a hero of mine), I was lost to ballet forever. As a runner, my toes are largely off the hook - but instead I've come to understand the importance of Good Feet!

Last week I went to a conference about running injuries. As a physiotherapist it's an interesting day, but as a physiotherapist and a runner it feels like an indulgence. The lecture that has stayed with me was about Medial Tibial Stress Syndrome (MTSS) or, as you may know it, Shin Splints.

Let's cut through the jargon a minute because in medicine things are often called fancy things but generally it can be simplified... "Medial" means inner; "Tibia" is the big bone in your lower leg; "Stress" in this case is the forces acting on it; and "Syndrome" is a collection of symptoms. So MTSS means that the inner bit of the bone in the lower leg hurts because it has forces acting on it.

The speaker (podiatrist Paul Harradine) was suggesting that the pain symptoms we feel when running with shin splints are a result of the forces we exert on our tibia, and a subsequent reaction of the bone around the area where the soft tissue attaches to it. Some of these forces are unavoidable and some can be managed.

Right then... the science bit. *flicks hair* The tibia experiences a force from above (the weight of your femur and upper body), and a force from below (the planet). It tends to bend inwards as we land - meaning that the outside of the tibia has a compression force and the inner part has tension force. (Imagine bending a baguette - eventually it would break apart on one side and squish on the other... and you could spread some delicious cheese on it.) Anyway... the inner side of your tibia is the bit being pulled to breaking point.

There are muscles that attach to the inner tibia which go down to the underside of your foot - so if your inner foot arch drops down as you run, it tugs those muscles down, increasing the bending force that your inner tibia already has to deal with. This can cause a stress reaction in the bone at the point where the muscle joins the tibia, and from there the possibility of a stress fracture or even a full fracture.

Unless you're the assistant to an awful magician or a clumsy chainsaw juggler, you can't take away the force from above (although we all know how to reduce it but I'm definitely not getting into a dieting discussion). We also can't take away the force from below - but we can help the situation by looking at foot positioning.

There are plenty of factors to consider when assessing problems, such as running style, muscle strength and even diet choices - but gait analysis is one place we can start that tells us if there's a definite problem that needs to be fixed. Good analysis will show you what your feet do when you run - and whether they're good or naughty! There's no real sense in looking at your arches as you stand still - what matters is how they behave when you're moving - a person with beautiful arches whilst standing can pronate like a good 'un once running.

The idea is to correct the pronation and eversion (dropping the arch, heel collapsing inwards) that occurs as you land and roll through on the foot. Helping your heel bone to stay vertical and prevent the arch dropping will encourage those naughty feet to behave. Video analysis can tell you whether you need a motion control shoe (support along the whole arch), a stability shoe (support on the inner heel), or orthotics - or both.

If you haven't been properly fitted with shoes then you should - and combining it with a good gait analysis makes sense. You might have to pay a little extra for the service, but any good shop that offers analysis should have an equally good returns policy if the shoes don't work out.

This isn't meant to scare you into visiting a podiatrist or running shop to be analysed and corrected. If you don't have pain, don't worry. We've all seen a runner at a race who looks like an out-of-control windmill-bot as they sail past you in the last mile. It's not necessary to have the perfect running style to get results.

But if you have even have a small amount of pain in that inner tibial area, get your legs and shoes checked by your local Physiotherapist, Sports Massage Therapist, running shop or Podiatrist. In my experience, this bony reaction is usually accompanied by a soft tissue reaction, and the tendons on that inner shin will need attention as well as the shoes. Don't leave it, don't run through it, and don't put your fingers in your ears and hum the Swop Shop theme tune.

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  • Good Toes Bad Toes I still use this exercise with the groups I lead as it is a good ankle strengther:) Neol Edmunds was a hero of my teenage years also :-o
  • good article I can relate to the naughty feet/ballet part and also got distracted with the crusty bread and cheese!
  • will get my daughter to read this when she gets home this afternoon as she has had recurring shin splints this past year - and get her to get her gait analysed - interesting article - thanks
  • Fab article the science bit was very well explained :-)
  • Yup ballet didn't hold my interest for long either! Great article thank you :-)
  • I depise Noel Edmonds and all he stands for.
  • Good article! I had a gait analysis done a couple of months ago by a local sports physio. I found it to be a really useful and interesting process.
  • I now know the difference between stability and motion control shoes :-) Great article :-)
  • What kind of delicious cheese can be spread
  • Where has my question mark gone
  • Mainly Brie. Also St Agur.
  • I also ditched ballet because the classes clashed with Swap Shop. I was 6. Clearly 70s children's programmes are the reason for the demise of high art. Although as I'm probably the windmill-bot I don't think I was such a great loss to the world of dance. Interesting article - thanks :-)
  • Great article - as someone whose right ankle does collapse when running and has ended up with a dodgy knee I would definitely extol the benefits of proper gait analysis and good shoes.
  • Yay Katie that was such a well written article very easy reading and I will hold my hand up to being the Windmill bot but one with no style but that doesnt overtake everyone or even anyone :-)
    I love it makes total sense :-)
  • Fabulous article!
  • Good article. I have never thought of my shins as tasty baguettes before but during a long race I imagine this could be quite helpful. Distracting anyway.
  • great article.
  • The (mis-)use of the term 'pronation' really bugs me it isn't pronation that support shoes are looking to correct; it's over-pronation which is the rolling of the foot past the point of 'neutral' which we want to minimise (and not completely inhibit through too much support otherwise our muscles etc won't ever adapt (but that's a discussion for another day)).
    Also putting unnecessary support under the arch isn't necessarily the way to go to help the arch. The arches are designed to collapse and re-form with each step and shoving some dual density EVA under there isn't going to help matters. Don't mean to sound moany and miserable it's a good article interesting point about the baguette an image I've not come across before.
  • Hi Brandstifterin: I wouldn't suggest an unnecessary support only if it was needed. I've mentioned there are plenty of factors involved in this syndrome (muscle strength etc) and this article is really just to explain the syndrome and suggest a place to start with it. I would always advocate soft tissue work intrinsic foot muscle strengthening and a specific stretching programme.

    Once the foot has moved past neutral it is pronating so I don't think I've mis-used the term although I wonder are you measuring pronating as a certain number of degrees and then over-pronating as more than that I would be interested to know where you define the difference Happy to fmail with you about this. I don't think you come across as moany or miserable at all. Thanks for commenting. :-)
  • Oh and all my question marksin that comment have gone. :-)
  • Great article. I was always more of a bucketeer! You of all people should be allowed question marks! :-)
  • Brilliant article.I used to get quite a bit of pain in my ankle and lower back on my left side and i went to greaves sports in Glasgow and had my gait analysis done and i had slight over pronation on my left side.I got a pair of adidas supernova glide with the support bit in the sole and have been pain free and happy running ever since:)
  • 01-811-8055 I wonder if he'll still answer the phone?
    Great article...*strokes good feet*
  • I have the easy solution... remove the planet! .. job done!
  • I got thrown out of Ballet age 5 because I didn't agree with 'good toesbad toes' :-)
  • It is a well written article :-) .....BUT would suggest including running technique as a method of correcting those naughty feet. I believe in many cases using one's own biomechanical movement to make the correction is a long term correction....(note I am not a fizz/gp or anything but have had the fortune of having plenty of practice helping people realign themselves and throwing away their orthotics/support shoes)
  • RF - running style is referred to in the paragraph that begins 'There are plenty of factors...' - and when it came to editing the article it was the paragraph we spent most time on. Katie was very keen to make sure it reflected the fact that there are many relevant approaches to treating this problem. I'd also be very keen to publish any articles that provide a clear understanding of running technique issues.
  • okee dokee - had overlooked that part. Will see if a collective group of us can do something as there are some very knowledgeable/biomechanically aware pHD folks lurking. In the meantime see:
  • Interesting piece. As a stress analyst I find the term 'stress fracture' slightly strange as with the possible exception of things like chemical attack all fractures are linked to stress (or more specifically a high stress) but as it's not a definition you've created you can't be held to it! Could you clarify the distinction between 'stress fracture' and 'full fracture' in your use - do you mean micro-fractures/cracks in the former case and full total breaking across a section of bone for the latter?
  • I agree on the importance of looking at running style as well as gait and shoes. CT was able to help me sort my long standing Achilles problems by talking me through looking at how my foot hit the ground (the planet) and the straightness of my Achilles on take off. This was a few years ago and so far so good.
  • I think if anything has come out of this article for me it's that I need to be much clearer about my position because although I've briefly mentioned that I believe there are many factors in improving this condition and preventing it leading to stress fracture I don't think I made that clear enough. As a Physio I look at all sorts of factors not just the shoe and whether it needs changing and I don't believe it always does need changing and I don't believe orthotics are always the fix either. I do think running style/technique is very important but that needs to be done along side strengthening and stretching and possibly soft tissue work (sports massage) as well. I tried really hard to make that clear in the final edit but it obviously hasn't come across. I don't think that one thing is the answer but it's more likely to be a combination of things and what's right for one person won't be right for another.

    MudMeanderer-nope it's not my word or definition simply one that's commonly used and yes all fractures come about through stress. A stress fracture is usually one that has come through overtraining so micro cracks deepen and eventually become a significant crack. A full fracture in this instance would involve a crack reaching across the full thickness of bone. That's my take on it I'm sure other opinions are available. :-)
  • I thought this might touch a nerve (or electrical signal carrying organic membrane designed to convey instructions to or feedback from muscles or other organs in most life forms) - you've stepped into the Running Mechanics Twilight Zone. Well written enjoyable and most-importantly storm in a teacup-inducing article Ms B! :-)G
  • Surely this is just another way of explaining why running badly and by that I mean heelstrike ahead of hips/ straight legs/ long time on stance (rolling through) is bad for you. If you walk on the kind of stilts where you hold the tops to make relatively smooth progress you rotate the top of the stilt out slightly while you transfer your weight over its base effectively youre reducing the height of the stilt at that mid-point relative to its height when it lands in front of you and when you lift it up behind you. This smoothes out your forward motion and stops you from essentially bouncing up and down as you progress making you more stable and using less energy as youre spending less fighting gravity with each step. What youre describing the foot collapsing the inward force on the leg (demonstrated quite well by the picture in which it looks like the knee is also collapsing inward) is your leg doing the same thing its basically trying to conserve energy by getting out of the way. So while you can fix some aspects of this effect by e.g. strengthening your glutes to stop your knees coming in or propping up your arches with foam the excess height of your leg when it is straight under you relative to its height when you land and take off still needs to be compensated for. You might even be moving stress from joints to bone by these fixes. With bent knees and less time on stance (high cadence and short strides) it is much easier to maintain a relatively consistent height at your hips as you progress so theres less need for your legs to try to collapse inwards or outwards creating the damaging stress. But thats just what I think and I also think youre brave writing something thats always going to be picked at considering the range of views on the site. Thanks.
  • I don't know who stole my punctuation but be warned - there are severe penalties for that kind of thing.
  • Ok so writing in word and pasting in here ruins your punctuation. except full stops. How odd. Sorry if that comment is hard to read.
  • There was a comma after Ok on that one. Aargh. I'll just stop now.
  • Good article Mrs F. And interesting to get a slightly more traditional view than many on here. From a personal point of view since ignoring all the gait analysis and ditching the support shoes to 'correct' my pronation and learning to address the biomechnical causes rather than mitigating the symptoms my shin splints and knee issues have gone away. I don't doubt that support shoes can provide a tool in the armoury but IMO the major concern should be addressing the cause not the symptom. I'd wholly agree that gait analysis can be a good diagnostic tool to highlight issues but for some (the majority I suspect) trying to mitigate this with support shoes is addressing the symptom not the cause. Given the time and effort required to re-learn to run biomechanically correctly support shoes may be the only practical answer for those looking for a quick fix. Your 10:37 comment I think is saying something similar - maybe it'd be worth editing the article to make this more apparent?
    An article such as this is always going to polarise opinion but well done on bringing the debate out into the open.
  • Flanker-editing this article further may severely damage my health. The final edit took some time and the thing I agonised about was making it clear that I very much believe in addressing the cause it's truly truly what I do. In truth I didn't realise how controversial this article was but I think that's because I know what I believe in doing(addressing the cause and not just the symptoms) and because I know that about myself I didn't emphasise it enough in the article.

    Editing it now would perhaps make the comments seem strange too.
  • Loki-some really interesting thinking- thank you.
  • Mrs F. I think you're awesome. You've written an article really well got lots of feedback and you've responded to all concerns. You are awesomely awesome :-) xx
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Left foot pronating - see how the ankle has rolled inwards?

About The Author
Katie is a Chartered Physiotherapist and Sports Massage Therapist based in Bedford. She specialises in a number of areas, including sports injury, whiplash injury, back and neck pain, postural dysfunction and post-operative rehabilitation.
When cake and planet combine, the pressure on your tibia makes it bend inwards as you land. Coupled with pronation, this can cause the muscles that attach to the tibia to pull on it - which can cause a stress reaction, aka shin splints.
Picture: Getty Images /

Paul Harradine
Clinical podiatrist and director of The Podiatry Centre Ltd and The Foot Orthotics Laboratory Ltd, with clinics around Hampshire and Surrey. Since obtaining his BSc (Hons) Podiatry from Northampton School of Podiatry in 1994 Paul has gained an MSc and CertEd working in both NHS clinical specialist posts and educational settings before becoming a full time private practitioner in 2003. He lectures on the post graduate circuit and has published papers in podiatric, physiotherapy and orthopaedic texts on first ray function, plantar pressure analysis technology, taping, outcome studies, orthoses production and foot function theory amalgamation. His current areas of interest continue to be variations in foot orthoses production and the amalgamation of differing foot theory utilising an underpinning unified perspective. Paul is a keen sportsman and is married with five young sons.

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