Member Case Study: Heel and Shin Pain

author : AMSSM

comments : 0

I still have heel pain and shin pain, and now I've got a weird pain in the center of my foot. Do you think I should have an x-ray to make sure that I don't have a stress fracture in my foot?

Question from lenscher
I've had my shoes assessed and am wearing newish correct ones for my average feet. I stretch a lot with trainers, and I also do two long strength workouts per week that work on lower body strength. Unfortunately, I still have heel pain and shin pain, and now I've got a weird pain in the center of my foot, where, say, Jesus is shown to be nailed to the cross.

I've had massage therapy for mild plantar fasciitis, and that seems pretty well resolved. I rest when I need to rest and work out hard when I can. Do you think I should have an x-ray to make sure that I don't have a stress fracture in my foot? I've gone from couch to athlete in under six months, and I don't feel like I'm overtraining. Thanks.
 

Answer from Andrew JM Gregory, MD, FAAP, FACSM

Member AMSSM

As you probably have found, foot pain is very common in runners. I am not completely confident in my biblical anatomy, but the most worrisome cause of pain in the arch (junction of the midfoot and the forefoot) as you describe is a stress fracture. I do think you need to come in for a physical examination and an x-ray of your foot to look for a crack in the bone or callous (new bone formation).

You must realize, though, that x-rays are often normal early on in a stress fracture and can take three to four weeks to show changes. Also, it is very important for the clinician to know the exact point of tenderness so that the x-ray findings can be correlated with the clinical findings. Training errors are the most common cause of stress fractures, and most people don’t realize they are doing too much too fast.

Other contributing factors of stress fractures can be elicited at your visit to you Sports Medicine physician. Other common causes of arch pain are plantar faciosis, degenerative arthritis with or without bone spurs, and foot/toe extensor tendonopathies.
 

Andrew JM Gregory, MD, FAAP, FACSM
VANDERBILT UNIVERSITY
NASHVILLE, TN
 

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date: September 17, 2008