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shin splints

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Alternative Names
anterior shin splints, posterior shin splints, stress fracture, posterior tibial tendinitis, anterior tibial tendinitis

Shin splints is a term used to describe pain in the lower leg.

What is going on in the body?
Shin splints are generally caused by some form of vigorous athletic activity. The shin splints can result from overtraining during an exercise program. The splints can be created by overuse when a person exercises often and the lower leg is unable to withstand the chronic stress. The most common forms of exercise that cause shin splints are long-distance running, sprint running, and exercises that involve sudden starts, stops and jumping. These include basketball, volleyball, tennis, soccer, gymnastics and high-impact aerobics.

What are the signs and symptoms of the condition?
Symptoms of shin splints include a very intense aching pain in the lower leg or a sharp weakening pain in the leg with swelling.

What are the causes and risks of the condition?
The risks of this condition range from mild to a permanent disabling injury. The condition involves chronic fracturing of bone or chronic tendonitis, which is inflammation of the tendons. The possibility of a spontaneous tendon rupture or a pathologic fracturing of the leg exist.

What can be done to prevent the condition?
Prevention consists of wearing proper shoes for the activity being performed. Good arch support is very helpful. Slowly building up strength in an exercise program can be a key. Warming up and stretching before engaging in vigorous exercise is also helpful. Trying to do too much too fast can cause injury. Hard surfaces, such as asphalt and cement, can be very dangerous. Shoes should be watched carefully for signs of breakdown or excessive wear. If there is any worry that the shoes may not prevent the problem, the shoes should be retired and new shoes purchased.

How is the condition diagnosed?
The condition is diagnosed by checking for the different types of pain. Then the type of shin splint must be determined.

The most common form is inflammation of the tendon that runs down and behind the inside anklebone and hooks into the inside central portion of the arch. This tendon belongs to a muscle called the tibialis posterior. This muscle helps decrease the impact at foot strike. If a foot is excessively flat, this muscle can undergo quite a bit of strain and develop problems.

The next most common form of shin splints involves the tibialis anterior tendon. This tendon runs on the front of the leg and inserts onto the top mid portion of the arch. The muscle for this tendon is located on the upper outside of the shin. It is more common with anterior tibial shin splints for the muscle to be involved rather than the tendon. The symptoms are usually confined to the soft tissue of the muscle. A tight calf muscle usually causes these shin splints. The injury comes when the tight calf muscle limits ankle motion. This causes the foot to hit the ground with a great deal of force. The muscle tries to slow the foot strike. This leads to overuse muscle fatigue and eventually muscle inflammation and pain.

The third most common cause of shin splints involves stress fracture. The stress fractures commonly involve the tibia, or the large lower leg bone that connects to the knee and ankle. The condition is usually diagnosed by excessive pain with pressure applied to the front of the bone, where it is close to the skin. X-rays are often taken and can sometimes show abnormalities in the bone. Many times, x-rays do not show the problem and other tests are used. The most common test is a radioactive labeled technetium bone scan. The bone scan is performed by injecting the technetium into a vein. A special x-ray image is taken. The technetium has a tendency to concentrate in areas where bone is being deposited. A dark spot on the film would show a stress fracture.

Shin splints are usually self-limiting. The splints improve with a decrease in activity level or a change in shoes.

What are the treatments for the condition?
Treatment should start with decreasing daily activity levels. The injured area can be iced if the individual does not have a cold sensitivity or other contraindication. Anti-inflammatory medications can be used with caution. Analysis of the activity level and surfaces being used should be undertaken. For example, if the injury was caused by playing basketball on an asphalt court, this situation should be avoided. Shoes should be checked for adequate support.

In the case of tibialis posterior shin splints or tendonitis, the best treatment is usually good, supportive, motion control shoes and inlays. Prescription foot orthoses (shoe inserts) are very effective for the treatment if over-the-counter measures fail. Anterior shin splints can be treated with physiotherapy using a home program or more formal physiotherapy. Because the most common cause of anterior tibial shin splints is a tight calf muscle, stretching programs should be tried.

Stress fractures are more troublesome. It is usually necessary to decrease or discontinue exercise until the shin is no longer symptomatic. Again, careful attention to shoe selection is important. Good arch support is important. Occasionally, foot orthoses can be helpful. Stress fractures can sometimes become chronic. In rare cases stress fractures may require bone growth stimulator or surgery.

What are the side effects of the treatments?
There are very few potential side effects associated with the various treatments. Cold intolerance or hypersensitivity to ice may prevent its use. Anti-inflammatory medications can sometimes hide symptoms related to shin splints because of the pain-killing effects. This can lead to more damage. Anti-inflammatories have some potential side effects, which should be discussed with a healthcare professional.

What happens after treatment for the condition?
After treatment, a great deal of care should be used when selecting shoes.

Author: Bill O'Halloran, DPM
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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