Medial tibial stress syndrome (also known as shin splints) presents as pain to the front of the lower leg.  Shin splints are most commonly caused by inflammation to the sheath surrounding the bone (shin bone - tibia).  The pain and irritation results from traction forces (and overload) to the shinbone and the connective tissue that attach your muscles to the bone.

Some symptoms include tenderness to the inside of the shin, lower leg pain (relieved by rest), lumps and bumps on palpation (touching) of the shin bone, and sometimes swelling or redness to the area.

Some specific athletic activities can predispose you to shin splints, these include: running down hill or on a slanted surface, shoes that are worn out, or sports/activities that involve lots of starting and stopping.

Differential diagnosis:

Pain in your back can be contributed to by a number of factors, one major contributor is your postural alignment. This postural alignment extends right down into your lower limbs and feet. In some cases poor alignment of your lower limb and or foot can cause or add to your back pain. Things such as a limb length discrepancy (one leg longer than the other), and poor foot mechanics are a few factors in the lower limb that can result in back pain.

The Sesamoid bones are two small bones that sit under you big toe joint.  Sesamoiditis is associated with pain and inflammation of the area.  Sesamoiditis most commonly presents as pain with a gradual onset in the ball of the foot (especially the inside).  Sesamoidtis usually affects young people that are physically active.  Pain can be constant or aggravated by movement of the big toe joint (metatarsophalangeal joint), and swelling can sometimes be noted.

Sesamoiditis is usually caused by repetitive/excessive pressure on the forefoot.  The chronic pressure and tension to the first toe joint causes the surrounding tissue to become inflamed and irritated.  Any activity that places a constant pressure/force to the ball of the foot can cause sesamoiditis.  Another cause of sesamoidits is damage or trauma to the area.

Differential diagnosis for pain in this area include: arthritis, infection, nerve compression (digital nerve), fracture or stress fracture, osteochondritis, plantar hyperkeratosis (callus), flexor hallucis longus tendonitis (common in dancers), myofascial pain syndrome (pain referred from trigger point in intrinsic muscle).

Assessment involves palpation, joint mobilization, and a full biomechanical to rule out other causes for the pain.  Treatment can include the following interventions: rest, modified shoe, custom orthoses to redistribute the pressure, anti inflammatory use is sometimes required.  Some severe cases may require a walking boot to relieve pressure to the area.

A neuroma is term used to describe swelling of a nerve.  In the foot it commonly occurs to the nerves that run between the bones in the forefoot area (metatarsals), especially between the 3rd and 4th joints (where the medial plantar nerve combines with the lateral plantar nerve).  This type of neuroma is referred to as a mortons neuroma. 

Symptoms of a mortons neuroma include pain in the forefoot, often localized to the 3rd and 4th area of the forefoot.  Sometimes people report the sensation of ‘walking on a pebble’, radiating and or shooting pain up the foot, and/or numbness/tingling in the forefoot area. 

A through assessment will be performed by your podiatrist to assess the cause of the neuroma.  Commonly neuromas can be due to inappropriate footwear, posture of your foot, or mechanics of the way you are walking, which cause irritation or compression of the nerve.  This irritation and/or compression leads to swelling of the nerve. Treatment can include both conservative and surgical options.  Your Podiatrist may suggest footwear, padding or orthotics depending on the cause of your problem.

Metatarsalgia refers to pain and inflammation to the forefoot area of your feet.  The condition is common in athletes and people who have high levels of activity.  The inflammation arises from extra stress to the metatarsal bones in the foot (the long bones in your feet than extend to the forefoot –base of your toes).  Pain in the area can range from a dull ache, to sharp pain.  The pain is usually worse with activity and relieved by rest.

The extra pressure that leads to the inflammation can have a number of causes, including foot posture or mechanics, loss of fatty pad, footwear or activity.  An assessment will be performed to ascertain the cause of your metatarsalgia, this will determine a suitable treatment.  Treatment options range from footwear advice, padding, innersoles, or orthotics.

Achilles tendonitis is inflammation of the Achilles tendon.  The Achilles tendon attaches your calf muscle to your heel bone (calcaneus).  The Achilles tendon is very important as it allows you to lift your heel when you start to walk.

Symptoms of Achilles tendonitis include: pain in the back of the heel, difficulty walking, and you may also notices swelling, tenderness and warmth to the area. The common causes include overuse, poor foot posture and mechanics (adding strain to the area), inappropriate footwear, and increased body weight.

Diagnosis will be achieved through a thorough assessment.  Once the cause of the problem is ascertained, your Podiatrist will be able to implement an appropriate treatment plan.  Treatment will include methods to reduce inflammation to the area, along with reducing the strain on the tendon.  Methods to reduce inflammation include ice therapy, anti inflammatory use, and immobilization.  To prevent further strain, you may be advised to reduce or eliminate specific activities, alter footwear, or be provided with orthoses to improve foot mechanics, and stretching once the inflammation has reduced.