Information on Anterior Shin Splints
Shin splints are a common overuse injury of athletes, particularly in the beginning stages of training. Care must be taken to distinguish shin splints from other conditions with more dire consequences, such as stress fractures or compartment syndrome. Shin splints can generally be treated simply with rest and a gradual return to activity.
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Anatomy of the Lower Leg
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The leg is divided into three areas: the anterior, posterior and lateral compartments. Muscles in the posterior compartment are responsible for plantar flexion (imagine stepping on a cigarette butt with your toes). They also invert the foot (turn the sole inwards) and flex the toes. The lateral compartment is responsible for everting the foot, or turning the sole outwards. The muscles of the anterior compartment dorsiflex the ankle (raise your foot with your heel firm on the ground), extend or raise the toes and invert the foot. All three compartments are surrounded by thick fascia, or connective tissue. The pain of shin splints is usually localized to the anterior compartment and thus affects those motions particular to it.
Definition
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The term "shin splints" is not considered a diagnosis. Shin splints are considered an overuse injury, meaning they result when a particular group of muscles are used too much or repetitively. They are most likely to occur at the beginning of a new training program after a period of inactivity. The pain associated with shin splints typically disappears after resting and a gradual return to activity, and after the athlete becomes accustomed to the new activity. This typically takes 1-2 weeks. The physician should be sure to rule out a tibial stress fracture, which can be much more serious than shin splints.
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Differential Diagnosis
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The two most important differential diagnoses of shin splints are stress fractures and compartment syndrome. A stress fracture results from an imbalance between bone breakdown and creation. During the course of exercise, it is normal for a certain amount of bone to be broken down; during recovery, the bone is replaced with new bone. After a certain time, microfractures result where the imbalance occurred, and can result in a frank fracture. To differentiate a stress fracture from shin splints, feel along the front of your leg; stress fractures will have a more localized pain, whereas shin splints have a more generalized pain. Also, stress fractures tend to have a more horizontal pattern of pain; shin splints have a vertical pattern of tenderness.
Compartment syndrome is an emergency. It results from pressure building up within a certain space with a subsequent decrease in blood flow. The mnemonic for the clinical features of compartment syndrome is the letter P: pallor, pain out of proportion, pain with passive stretching, pulseless paralysis, paresthesia and paresis. Should you have these symptoms, seek medical assistance immediately.
Prevention
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Enter new sports very gradually. For instance, before undertaking to run a marathon, a new runner should first become comfortable running a mile, then a 5K, and so on. Also, certain stretches can assist with flexibility. One such stretch is dorsiflexing (lifting your toes with your heel stable on the ground) to the point of mild discomfort and then returning to neutral (put your foot flat back on the ground).
Treatment
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Treatment for shin splints includes rest and a gradual return to activity. Be realistic in your fitness or activity goals; if it hurts, it may be wise to stop. Shin splints typically resolve once the athlete becomes accustomed to the attempted level of activity. NSAIDs may provide some pain relief. Should the pain not resolve within a week or two of appropriate rest and stretching, follow up with a physician may be necessary.
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References
- Haller Paul R, "Chapter 278. Compartment Syndromes" (Chapter). Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6e
- McMahon Patrick J, Kaplan Lee D, "Chapter 4. Sports Medicine" (Chapter). Skinner HB: CURRENT Diagnosis & Treatment in Orthopedics, 4e
- Nikovits David A, Rodenberg Richard E, Armsey Thomas D, Hosey Robert G, "Chapter 37. Common Upper & Lower Extremity Fractures" (Chapter). South-Paul JE, Matheny SC, Lewis EL: CURRENT Diagnosis & Treatment in Family Medicine, 2e
