Hi,
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I have never posted on here before although often use this site as it's an excellent source of information. I am hoping for some advice/thoughts please?
I have recently been asked to treat a Hockey athlete for what the physiotherapist has diagnosed as 'shin splints'. He is 22 years old, slim and a strong athlete. He complains of pain on the medial aspect of the distal 1/3rd of each tibia. He has struggled with this on/off for a few years although the symptoms have become increasingly bad, limiting his training since June 2010. He is currenly been advised not to train.
I often find it difficult to make a clear diagnosis on a patient with these symptoms i.e. PTTD, MTSS, compartment syndrome. The physiotherapists and doctor are now considering pressure testing for compartment syndrome.
He has bilateral mild cavus feet and marked tibial varum, the rearfoot of inverted at initial contact with little rearfoot movement following heel contact. There is no significant coxa-valga/vara and the femoral neck angle appears normal.
The patient's previous podiatrist suppleid custom foot orthotics, 3mm polyprom with 4mm lateral heel posts. The patient explained that he did not notice any improvement with these orthotics.
I understand the reasoning for correcting the rearfoot with lateral heel posting and also wondered if perhaps the medial compartment required further stretching? However, as this method did not work my thoughts were that the loss of shock absorption and the marked tibial varum increase stress on tib. post. and increase the strain and bowing of the medial/anterior aspect of the tibia.
I supplied him with 2mm custom carbon fibre orthotics with medial heel posting. Initially his symptoms improved for 1 month although following a weeks intense training the symptoms have returned.
5 days ago I adjusted his orthotics and increased the medial posting. The athlete is comfortable wearing them walking although has yet to train in them.
The physio's and doctor are now considering pressure testing as they believe consercative treatment has failed although I wonder if my train of thought is in the completely wrong direction or if anybody has any thoughts on how to help??
Your feedback is greatly appreciated.
Thanks,
Mhairi F.
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