Shin Splints are extremely common amongst runners, especially when they start to increase their mileage from what is their norm. Athletes from other sports, such as basketball or soccer, can also develop shin splint from the pounding they receive from the court or grass. Increased tension of the muscles on the front and back part of the leg pulls on the covering of the bone (periosteum) and causes the constant inflammation and irritation to the area. The tibialis posterior , soleus and the tibialis anterior muscles are most common culprits in shin splints. Patients with shins splints will experience pain at the front or inside of their shins Treatment often involves rest, icing, anti-inflammatory medication, gentle stretching, and activity modification.
Pain at the front of the shin (tibia) is a key feature of “shin splints”. This pain is typically located over a broad area of the lower inside (medial) aspect of the shin. Shins splints are often associated with a history of an increase in activities such as extra walking on a hard surface; a new training regimen; or a long hike. Pain may initial improved with activity. However, with prolonged activities symptoms will be worsened. Start-up pain (pain first thing in the morning or after prolonged sitting) is common.
Shin splints occur when the attachment of the muscles originating from the large lower leg bone (tibia) become irritated. The attachment on the outer layer of the bone site (the periosteum) becomes inflamed (periosteitis) due to the repetitive traction of the muscles pulling on it. The muscles involved are the muscles of the “anterior compartment” and include the tibialis anterior, the extensor hallucis longus (pulls the big toe up), and the extensor digitorum longus (pulls the smaller toes up).
Medial Tibial Stress Syndrome (MTSS).
In some patients the muscles (tibialis posterior and Soleus) attaching on the inside and back part of the lower leg bone (tibia) may create symptoms. Here at Podiatry Clinics we have more experience than most of our peers in developing a successful management plan and return to activity for MTSS. We currently see injured Military recruits on a regular basis. We have developed a rehabilitation protocol and specially individualised orthoses designed to reduce load and increase shock absorbency. We can then offer our specialised running analysisand footwear advice to help reduce risk recurrence.
Shin splints needs to be differentiated from a stress fracture of the tibia which is a microscopic fracture involving the tibia bone itself. Generally a stress fracture creates more localized pain than shins splints, although sometimes imaging studies are required to differentiate the two conditions.
In patients with shin pain it is sometimes necessary to request Medical imaging to rule out a stress fracture. If the case arises then we willliase with your G.P or consultant to discuss this further. Common Imaging modalities include:
X-rays of the lower leg bones (Tibia and fibula) may be indicated to rule out any obvious stress fracture. However, in most instances these x-rays will be negative.
Occasionally, an MRI may be ordered to help rule out a stress fracture. Often there will be a localized area of oedema (characteristic of increased blood flow) where the muscle attaches to the bone. In patients with stress fractures of the tibia a localized area of oedema in the bone itself will be seen.
Often a “bone scan” will be ordered instead of an MRI to help establish the diagnosis. A bone scan involves injecting blood that has been tagged with low level radioactive tracers. A bone scan will “light up” in areas where there is a high blood flow. In patients with shin splints there will be a general low level increase in activity that is seen on the bone scan. This differs from a stress fracture of the tibia that will have a very localized high intensity area of involvement on the bone scan.
- Ingrowing Toenails
- Achilles Tendinopathy
- Ankle Joint Arthritis
- Heel Pain / Plantar Fasciitis
- Back Pain
- Bunions (Hallux Valgus)
- Hip Pain
- Shin Splints and Medial Tibilal Stress (MTSS)
- Metatarsal Stress Fracture
- Morton’s Neuroma
- Runners Knee
- Tibialis Posterior Dysfunction
- Toe Deformities