Monthly Archives: January 2009

Shin Splints

Reader Jason asks “I was wondering if you had more information about shin pain during running.  what could be the cause, what could be the remedy, etc.? “

Shin splints also known as Anterior Tibial Tendonitis can occur for a variety of reasons.


Here are the most common causes I see in my office.

  • Shoes – A soft lateral midsole or simply excessive wear can cause shin splints. If you haven’t had shin splints before  and then you do, you probably need new shoes. If the wear looks like this (especially the left) when you set your shoes on a flat surface, then excessive wear is probably the cause.


  • Over-training or changing running surface or terrain. A change to concrete from trails or an increase in downhill running can also cause shin splints.


  • Alignment – A condition called tibial varum (bowed legs) can predispose a person to shin splints as this causes the pull of the muscle to be angled versus straight, resulting in the muscle pulling away from the lower leg bone (tibia). If a person’s tibial varum is significant, it can also cause Achilles tendonitis or even a stress fracture of the tibia which becomes a serious problems activity-wise.

Whenever I have a patient with shin splints, I do a thorough treadmill evaluation with shoes on and off and make specific recommendations if the problem is the shoe. I will also do a complete medical examination including xrays, ultrasound and MRI if indicated.

If the problem is biomechanical (alignment)I will make a custom orthotic, especially if the pain has been long standing. If the problem is acute I will try taping, icing and over the counter anti-inflammatory medications (Motrin, Aleve). If this doesn’t work and the pain is really severe, I will probably do a cortisone injection, which typically works very well.

If the problem is over-training I have the person back it up and if it’s a change in terrain, I’ll recommend softer trails and/or fewer hills until the pain lets up. Physical therapy can also help.

Tango, Salsa and Ballroom Shoes – Jorje Nel Dance Design

I don’t usually get a lot of Tango dancers, but today RL came in with these beautiful Jorje Nel Design Dance Shoes The style is Fernanda Ghi. She found them online and sent in a weight bearing foot tracing along with her order to ensure proper fit. I think these shoes are fabulous for the following reasons:

  • Lacing from ankle to toe allows for depth adjustment, which is especially great if you have a wide foot.


  • Mesh upper accommodates bunions and hammertoes allowing for a more variable fit.
  • Waist width is wide which will provide  more overall support of the foot while dancing.


What I don’t like, is that even though a weight bearing tracing was sent in, the overall length was easily 2 sizes too short because RL has a longer heel-to-ball measurement than heel-to-toe.  For why this is important, see my related post

If you are a tango dancer and you purchase shoes from Jorje Nel Design, you will want to know whether your heel-to ball or heel-to-toe measurement is longer and not only have them use your foot tracing but your proper length (heel to-ball or heel-to-toe, whichever is longer) measurement as well.

All in all though, if the length is correct then I am a big fan of this particular shoe.

Shoe Review – Gel Kayano 15 vs 14

The new Gel-Kayano 15 recently debuted and at first glance I was very excited. The Gel Kayano is at the top of my list for narrow, shallow feet and is narrower than any other of the current Asics available now.

1. Toebox Depth and Length – The 15 has a deeper toebox than the 14 which helps for those whose 5th (baby) toes were getting crowded or develop a corn when wearing the 14 which was the biggest problem I found when people switched from the 13 to the 14.

It also is slightly longer which helps if your heel to toe measurement is bigger than your heel to ball measurement.



2. Midsole Construction -This is a significant change from the 14 and may create problems for many runners who were otherwise running pain free in the Gel-Kayano 14. The design is more like the Gel-Nimbus 10 which is one of my least favorite shoes.



The 14 has much more EVA in the lateral (outside) midsole than the 15. This means longer wear and greater support at heel strike with the 14 than the 15.

This difference is HUGE, so make sure if you decide to upgrade, you have a professional evaluate you in both pair as the 15 may make your heel strike more wobbly causing things like ankle sprains or tendonitis. Everyone doesn’t necessarily need firm lateral EVA but if you do, you would be better off with the new 2140 than the Gel Kayano.

3. Asymmetrical Lacing – According to Asics this system of lacing “conforms to the bony structure of the foot for an enhanced fit” – My findings and common sense both say, No. In fact this lacing tends to pucker the toebox area for a worse fit, creating an elf-shoe-like appearance with no benefit whatsoever, except maybe irritation at the base of the toes. In fact, I wound up re-lacing as below to simulate a normal (and better) straight lacing design. If you wear this shoe, I would recommend that you do this too.


All in all, I’m very disappointed in the Gel-Kayano 15 and will probably not be recommending this shoe for as many of the runners that come in as I did with the 14.

Note – I have also reviewed Gel-Kayano 16, the post can be found at

Shoe Review – Asics 2140 Has Arrived!

When puts  a particular running shoe on sale, it’s usually because they are clearing the way for an upgraded model. This is the case with the new Asics GT-2140 which are replacing the GT-2130.

Unfortunately, these two shoes are not the same.

1. Width – The 2130 is much wider overall than the 2140. Great if you have a narrower foot, not so great if you have a neuroma, metatarsalgia (ball of the foot pain) or a bunion. If you have these conditions, you will want to try both the medium and wide widths on to determine which fits the best.


2. Toebox Length – 2140 has a longer toebox with a more acute pitch than the 2130. This will benefit those having a longer heel to toe than heel to ball.


Overall, I like the new look and slightly more cushioned design of the new 2140. My only concern is how narrow it is. In fact it reminds me more of the older 2120’s. All in all though, this is a great stable shoe which will also accommodate an orthotic perfectly.