Anatomy

The lower leg is made up two long bones — the tibia (shin bone) and the fibula — which connect the knee to the ankle and provide stability and allow transmission of force up and down the leg.

Muscles

The muscles in the lower leg allow for movement of the foot and ankle, and can be divided into three groups:

1. Anterior

• Located at the front of the shin and move the foot and toes upwards (dorsiflexion)
• Contain the muscles tibialis anterior, extensor digitorum longus, fibularis tertius and extensor hallucis longus

2. Lateral

• Located on the outside of the leg along the fibula bone and move the sole of the foot outwards (eversion)
• Contain the muscles fibularis (peroneus) longus, and brevis muscles

3. Posterior

• Located at the back of the lower leg and move the foot and toes downwards (plantar flexion) and the sole of the foot inwards (inversion)
• Contain the muscles calf (gastrocnemius and soleus), plantaris, popliteus, flexor digitorum longus, flexor hallucis longus and tibialis posterior

Common injuries of the lower leg

Shin splints – Medial tibial stress syndrome (MTSS)

Pain at the front of the shin is often referred to as shin splints however a more accurate diagnosis is MTSS.

MTSS is caused by repeated trauma to the connective tissue and muscle surrounding the tibia, resulting in inflammation and possible micro fractures. Pain is reported along the bottom two thirds of the shin with tenderness along the bone.

What causes it?

• Biomechanical issues: Overpronation of the foot and ankle (excessive rolling inwards)
• A sudden increase in intensity of frequency without the necessary strength and conditioning
• Weakness in the muscles of the leg, particularly the calf and hip gluteal muscles
• Poor running technique

Management

• Reducing the load on the bone: it’s important to cease aggravating activity until pain has settled
• Targeting the errors: Address training/technique errors and strengthen weak muscles and review footwear
• A gradual return to exercise facilitated by your physiotherapist

Calf muscle tears

The calf muscle is made up the gastrocnemius, soleus and the plantaris which come together to form the Achilles tendon. The gastrocnemius is the most superficial calf muscle and crosses both the knee and ankle joint making it more susceptible to injury.

What causes it?

• Often it’s due to a sudden movement forcing the ankle upwards into dorsiflexion — common in sprinting or quick lunges
• A diagnosis and prognosis will need to be done by your physiotherapist and in some cases, you may require further imaging tests

Management

• Initially, we need to let the injured muscle heal: Protect Optimal Loading Rest Ice Compression Elevation (PRICE)
• A period of reduced activity and rest
• When indicated, a graded exercise program as directed by your physiotherapist to strengthen and increase flexibility of the calf muscle
• Identify and strengthen deficits like muscle weakness, poor training and running technique

Tight calf muscles

Tightness in the calf muscles is a common complaint and is associated with a fear of increased risk of injury however, tightness in a calf is usually a sign of weakness of the calf muscles. This is particularly evident as it is a common presentation in runners where we know the main muscle working is the calf. Stretching can be helpful in this situation with symptoms, but it will not change the overall problem. A calf strengthening program is essential and can be tailor made by your physiotherapist.

Achilles Tendinopathy

The Achilles tendon connects the calf muscles onto the heel of the foot and due to the large amount of forces that go through this tendon, it is a common tissue to injure.

A tendinopathy is caused by a repeated overload of the tendon. This results in excessive tissue damage with insufficient repair, causing the tendon to be less efficient and less able to perform its job. The discomfort is always specific and localised (one finger width) and occurs usually in two main locations: in the middle (mid-portion) on the heel bone (insertional). Management of an Achilles tendinopathy focuses on initially settling symptoms followed by developing load tolerance in the tendon. This will require a structured exercise rehabilitation program over an extended period of time (six to 12 weeks) and is absolutely essential in order to overcome such an injury and to help prevent reoccurrence.

Lower leg treatment with Life Ready Physio

With expert treatment such as joint mobilisation, massage and therapeutic exercises for improved functionality, Life Ready Physio will not only alleviate lower leg pain — we’ll provide you with the tools to prevent future injuries too.

For an in-depth assessment by one of our skilled physiotherapists, book a consultation here.

We look forward to joining you on this journey to pain-free living.

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