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June 21, 2021: Shin splints & metatarsalgia – a guest blog by Jeremy Ousey MSc MCPod

Do I have shin splints?

Frequently patients come into clinic complaining of conditions like shin splints and metatarsalgia.

These are two ‘diagnoses’ which are common labels used by many people, healthcare professionals, sports professionals and our friend Geena who works down the club and gets that exact same pain in her foot… We can all be guilty of it, but what do they mean and why is using these terms a problem?

Well… I’m sure we’ve all had that moment where we are laying in a dark room having maxed out on the pain killers we have in the cupboard and hoping that the clock quietens down with its ticking because it’s making that throbbing in our head feel even worse.

Then that thought comes into our head, “what is causing this pain??? Is it dehydration? Is it just a migraine? Maybe I ate something… and that is a stark reality, we can have pain in an area and not realise what’s causing it and while a migraine compared to an achy forefoot (metatarsalgia) is quite a contrast, we wouldn’t want the doctor treating our migraine like a hangover, and even less would we like him to treat our hangover like a migraine!

So why are shin splints, metatarsalgia and arthritis such a series of misnomers? Well, let’s break them down…

Shin splints

Shin splints is a term that gets used so interchangeably that it’s hard to know what people mean, but the commonly accepted diagnosis that it is linked to is “medial tibial stress syndrome”.

This being said, it can be used for multiple tendinopathies, exertional leg pain and even apophysitis (stress/injury to muscle/tendon attachment in children) such as that of Osgood-Schlatter’s.

Medial tibial stress syndrome is really a low grade stress reaction in the tibia that is typically the result of torsional (twisting) forces as the foot, ankle and leg make contact with the ground, ultimately causing a very low grade stress response (the precursor to a stress fracture).

So when its put like that, we’re dealing with a few different potential diagnoses… so if the diagnoses are different, surely the treatment has to be too? Let’s look at metatarsalgia…

Metatarsalgia

Metatarsalgia, when the word is broken down means “pain in the forefoot”. It doesn’t include toe pain, although the pain can radiate into the toes.

Metatarsalgia can be the result of inflamed joints, overloading of tendons, structural anomalies, arthritic changes or swollen, inflamed or trapped nerves. All of these things can cause foot pain, but the treatment for the specific condition should need to be different for each problem.

Arthritis

Arthritis is a highly generic term but in reality has a very specific meaning which varies on context.

There are various types of arthritis – osteoarthritis, rheumatoid arthritis, psoriatic arthritis etc, but quite often a diagnosis of arthritis may be made based off of an x-ray due to a narrowing of the joint spaces – which is actually typical in a huge proportion of the population who are “over a certain age”.

That said, the presence of arthritic changes do not necessarily mean that pain is guaranteed; in fact, there are a huge number of people walking or even running around whose knees are “bone on bone” with minimal or no pain. Equally there are a huge number of people who have joint pain but an x-ray examination shows no signs of that dreaded “wear and tear”.

There is a real paradigm shift going on within healthcare where we are concerned about the language we use and what that language means for our patients.

Equally, there is general misdiagnosis being made by those less experienced in diagnosing foot pain, and as a result I see many patients who go through life suffering with their feet for years until they get the correct diagnosis.

Always make sure that you get a diagnosis when you see a clinician and are not given a generic condition such as shin splints or metatarsalgia… 

About Jeremy Ousey MSc MCPod

Jeremy Ousey  is an HCPC registered Podiatrist and CASE qualified sonographer.

Having worked in podiatric surgical units, physiotherapy and multi-disciplinary practices, he takes a multi-faceted and patient-centred approach to care. With a bachelors in Podiatry, postgraduate degrees in podiatric sports medicine and medical ultrasound and a masters in the theory of podiatric surgery he allows evidence to guide his treatment plans.

Jeremy lectures on heel pain, extra-corporeal shockwave therapy, musculoskeletal examination, treatment of the foot and ankle including management of ankle sprains and verruca needling.

His interests are in the surgical management of skin lesions, nail surgery, musculoskeletal and biomechanical evaluation, acute and chronic sports injuries, tendinopathies, diagnostic ultrasound and surgical management of foot and ankle pathology

If you would like any more information or to book an appointment with Jeremy then please call Maidenhead Podiatry & Chiropractic Clinic on 01628 773588 or email info@maidenheadpodiatry.co.uk