As summer turns into fall, we always seem to notice an influx of people coming into the clinic with lower leg pain, whether that’s foot, ankle or shin pain. Keep reading to see how Osteopathic Manual Therapy may help!
Anatomy of the Lower Leg
Let’s start with the anatomy of the lower leg. There are 28 bones in each lower leg, which is a lot when you consider there are 206 in the entire body. The tibia (shin bone) and the fibula run from the knee to the ankle and that leaves 26 for the foot and ankle – 7 tarsal bones, 5 metatarsals and 14 phalanges. The talocrural joint consists of the talus, tibia and fibula and is responsible for pointing and flexing the foot. The subtalar joint consists of the talus and calcaneus and is responsible for pronation and supination, this is the area of the common ankle sprain.
The lower leg, ankle and foot work to provide stability for the body, but also needs to remain adaptable as it is a shock absorber, in addition, to ensuring we can walk upright! Talk about a tough job being mobile, yet stable.
Common Conditions
The lateral ankle sprain, where the subtalar is inverted (think a rolled ankle). They can be graded on a scale of 1-3 depending on the extent of ligamentous damage. The ankle sprain can disrupt the joint mechanics of the subtalar joint but also further down into the foot and up the leg. We’ve seen patients where headaches resolve once we treat an old ankle sprain based on the tension in the fascial body originating at the foot. This is why we tend to ask about sprains/strains when we do our history during your first visit.
Plantar fasciitis is another common condition we see. This is an inflammation of the plantar fascia most commonly described as pain along the bottom of the foot running from the heel towards the toes, worse in the morning when you get out of bed or after standing up after sitting for a longer period of time. This condition can be the result of a change in footwear, heels, an increase in training or activity, poor foot biomechanics, or even a pelvis that is out of alignment. It can be seen unilaterally (one foot) or bilaterally (boot feet at the same time).
Achilles tendonitis is another frequent condition of the lower leg. This is an inflammation of the sheath of the Achilles tendon which attaches into the calcaneus (heel). It can originate from an overuse injury, or from an increase in friction or traction of the tendon. With Achilles tendonitis, you can have symptoms that include heel pain, you may note a decrease in range of motion, in addition to point tenderness along the tendon or into its insertion at the heel.
Shin splints as they are commonly called, otherwise known as tibial stress syndrome, is another frequent complaint from patients. This is an inflammation of the muscles/tendons that flex the ankle or toes. It is common to see this at the posterior medial (back and inside) portion of the tibia. With shin splints, you also need to think about stress fractures if the pain persists and refer to a physician if this is suspected. Shin splints can be caused by poor foot biomechanics (if you excessively pronate or supinate), tight calf muscles, new shoes, a change in workout surface, an increase in activity, or essentially anything that changes the foots ability to be a shock absorber so that the shin is forced to absorb the forces when it is not designed to do so.
Osteopathic Approach
So why are the feet so important? We stand and walk on them a lot – which means they work hard every day. They are responsible for keeping us upright and for our ability to move and stay balanced. The feet can influence the rest of the body by way of our central line of gravity and in return, they can be impacted by forces coming down that same line of gravity from above. In addition, the foot is connected to the remainder of the body by way of the fascial chains. Seems like enough reasons for them to be important to our health and wellbeing!
The feet are often under treated in our health care system and should not be neglected! Your Osteopathic Practitioner will take a detailed history (see Sine’s previous blog in this regard!) and will generally ask about sprains and strains that you have experienced, feet included! Most patients shrug off the question as they don’t see the link between an old ankle sprain and their current complaint. However, if you think about it, you sprain your ankle, you limp around on it for a couple weeks…you can just imagine the compensations and adaptations that you develop to help off load the stress on the ankle/foot while it is healing.
Following the history, your Osteopathic Practitioner will include an assessment of the lower legs as part of their overall assessment and will work to determine if the foot/ankle condition is originating in the foot/ankle or if it is the resultant symptom due to dysfunction elsewhere in the body. Once the assessment is complete, the Osteopathic Practitioner will use a variety of techniques to help restore the joint mechanics of the lower leg. A variety of techniques can be used depending on the length of time the dysfunction has been there, including decompaction, muscle energy or fascial work.
Get in touch if you have questions!