Shin splints

Shin Splints is a layman’s term for pain that arises in the legs around the shin bone (tibia) or in the leg.

There are three muscles groups that can be involved in this condition. The medial group consisting of the posterior tibialis, flexor hallucis and flexor digitorum muscles. This group runs down the inside or medial side of the shin.

Tibia frontal view.

Tibia frontal view. (CC by SA 2.1 JP)

The Anterior group consists of the Anterior Tibialis, Extensor Hallucis and Extensor Digitorum Muscles, and it runs down the front or anterior side of the leg.

The Lateral Group consisting of the Peroneus Longus, Peroneus Brevis and Peroneus Tertius muscles and runs down the outside or lateral side of the leg.

The most common site of pain on examination is on the lower 1/3 of the leg on the Medial side. It can manifest as tenderness in the Posterior Medialis muscle, or it can be more severe with sharp pain along the border of the Tibia or in isolated spots on the bone.

On the Anterior side it commonly manifests as tenderness in the Anterior Tibialis muscle body on the upper 1/3 of the leg. On the Lateral side it can manifest similarly to the medial side with the Peroneus Group, on the lower 1/3 of the leg.

There are different levels of shin splints injury.

  • Anybody that pronates excessively can be prone to overworking these muscle groups. One can experience tired burning legs on walking and, depending on the intensity of activity, the condition can worsen and become more inflamed.
  • Muscle soreness, periosteal inflammation, periosteal separation – bone splints and stress fractures can occur as the severity gets worse or the management is delayed.
  • The most common type involves the medial tibial group. Referred to as medial tibial stress syndrome, it is common in those who pronate excessively, as these muscles will be required to do more work than normal to resist the pronation of the foot.
  • The anterior group comes into play in those that have delayed forefoot Pronation as a consequence of a foot that strikes Supinated (lateral). In those that have tight calf muscles the Anterior Group will have to work harder to maintain the balance.
  • The lateral group can be involved in those that have a hypermobile 1st ray which is the 1st Metatarsal that has the ability to move too much in an upward direction. This leads to pronation causing the Peroneus Longus to overwork as it is attached to the base of the 1st Metatarsal.
  • Those that strike Supinated, may stress the Peroneus Brevis or Tertius.

The injuries are often associated with sports that are repetitive, like long distance running, although it can occur in any sport. It can occur in walkers and those who do not participate at all. An elderly person with dropped arches can experience leg pain as well.

In each case there are underlying biomechanical principles involved. One has to identify them to find the cause.
Structural Mal-alignment, Muscle Imbalances, footwear issues all have to be evaluated to deal with the problem.

How shin splints are treated

The Podiatrist is able to assess the factors involved in order to prescribe the correction necessary to assist in recovery.

Treatment may involve a multi-disciplinary approach. Biomechanical correction using inserts, orthotics to improve foot function. Physiotherapy for assisting recovery and Biokinetisist for muscle imbalances, stretching and strengthening.