“Shin splints” is an outdated term variously used to describe pain in the lower leg. It is, however, still in common use today.

Medial shin splints are defined as pain in the lower aspect of the medial (inside) tibia 3 to 12 centimeters above the tip of the medial ankle. There is tenderness to touch in this area along the posterior (back) aspect of the tibia bone. The muscles and tendons are inflamed as well as the membrane (periosteum) around the bone. This is where the medial leg musculature attaches to the bone. This is a repetitive stress (overuse) injury. The most frequently involved muscle is the Posterior tibial muscle, but the Flexor digitorum longus and the Flexor hallucis longus muscles may also be involved.

Medial shin splints are common in athletes who are increasing their level of activity or its duration. It may also occur during transitioning from one sport to another.

Anterior shin splints are soft tissue injury at the origin on the anterior tibial muscle along the anterior-lateral (front towards the outside) aspect of the lower leg. There is tenderness to touch in this area. The muscle and its attachment to the bone are inflamed. Like Medial Shin Splints, this is a repetitive stress (overuse) injury.

Anterior shin splints frequently occur in athletes beginning a weight bearing exercise program. Overtraining of more seasoned athletes is sometimes responsible.

Foot orthotic devices can provide support for stressed joints and soft tissues. They are often constructed to increase shock absorption. The redistribution of weight relieves stress on the metatarsals. Generally, custom-made semi-rigid or semi-flexible functional posted orthotics are most effective for this foot type. They often include shock absorbing material in the arch. These devices are prescribed based on a thorough biomechanical examination by a qualified podiatrist. Orthotic therapy is very effective for patients with this foot type. Over-the-counter arch supports may be helpful for mild cases, but they are often a poor fit for persons with this condition.


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Symptoms

  • A dull pain, aching in nature, along the lower half of the medial (inside) aspect of the tibia
  • As the condition advances, the pain may become sharp and occur earlier with activities (Medial Shin Splints, OR
  • The anterior aspect of the lower leg (Anterior Shin Splints)
  • Firmly touching this area may be uncomfortable

Causes

  • Excessive foot pronation or pronated foot structure (e.g. flatfoot)
  • Poor conditioning and/ or inadequate stretching
  • Running on a slanted or hard surface
  • Excessive downhill running
  • Abnormal alignment of the joints of the lower extremity
  • Unsupportive shoes and poor shock absorption
  • Tight calf muscles
  • Muscle imbalance
  • Overtraining

What you can do

  • Decrease activity immediately, gradually resume when symptoms have subsided
  • Maintain fitness with non-weight bearing exercises
  • Wear shoes with a good cushioning and arch support
  • Apply a tensor bandage to the foot and lower leg, with only moderate compression decreasing as you wrap up the leg
  • Control body weight to decrease load on the feet
  • Ice the tender area three times daily, especially after activity
  • When not painful, strengthening exercises of the muscles that invert the foot
  • Stretch the muscles of the lower leg
  • If tolerated, OTC anti-inflammatory medication (e.g. aspirin, ibuprofen)
  • In mild cases, OTC arch supports may be of benefit

What the doctor may do

  • Prescribe physical therapy modalities
  • Recommend shoes
  • Evaluate your training routine
  • Initiate exercise and stretching programs
  • Recommend shoes
  • Perform a thorough biomechanical examination
  • Prescribe functional foot orthotic devices to control foot pronation, these are very effective for this disorder
  • Surgically correct a severely pronated foot.

Other causes of lower leg pain

  • Compartment syndrome, exercised induced increased compartment pressure, which may occlude blood supply
  • Tibial stress fracture may be confused with shin splints, and can be ruled out with a bone scan
  • Occlusion of a vein by blood clot (venous thrombosis)
  • “Bruised” muscle from blunt trauma