Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Shin Splints

Basics
Description
  • Shin splints present with pain and discomfort in the leg from repetitive running on hard surfaces or forceful excessive use of foot plantarflexors.
  • Synonyms: Medial tibia stress syndrome; Periostitis of the tibia; Runner’s leg
Epidemiology
Shin splints occur commonly in teens and young adults.
Risk Factors
  • Running or jogging, especially a recent increase in distance or speed
  • Pronated feet
  • Training errors
Etiology
Periostitis at the origin of the posterior tibialis muscle or the soleus muscle at the medial tibia or the soleus muscle
Associated Conditions
  • Usually affects conditioning athletes
  • Any deformity of the leg (e.g., pes planus) that increases stress on the leg may predispose.
Diagnosis
Signs and Symptoms
  • Exercise-induced pain occurs along the posteromedial border of the distal tibia.
  • Pain usually is dull, but can be intense, and is present at the onset of the workout.
  • Pain may persist after the workout but eventually dissipates.
Physical Exam
  • Tenderness to palpation along the medial border of the tibia
  • Pain with resisted plantarflexion and inversion
  • The clinical presentation of medial tibia stress syndrome may closely resemble that of stress fractures and exertional compartment syndrome, which can carry a far worse prognosis if undiagnosed.
  • Exertional compartment syndrome has characteristic physical findings of anterolateral leg pain, commonly over the anterior compartment; fascial hernias may be present.
Tests
Imaging
  • Serial plain radiographs are normal but are needed to rule out stress fractures, which usually are positive after 2 weeks of symptoms.
  • A bone scan may reveal diffuse longitudinal uptake along the posteromedial border of the tibia, whereas a stress fracture is a localized or transverse uptake on bone scan.
  • MRI also can be used to identify a stress fracture earlier.
Diagnostic Procedures/Surgery
Compartment pressure measurement with exercise may be needed to diagnose exertional compartment syndrome if pain is anterolateral.
Pathological Findings
Inflammation at the origin of the soleus or PTT on the tibia
Differential Diagnosis
  • Stress fractures
  • Chronic exertional compartment syndrome
Treatment
General Measures
  • Reduce training activity below symptom level
  • Ice on the area of injury
Special Therapy
Physical Therapy
  • Therapist-determined modalities
  • Strengthening and stretching exercises after acute symptoms disappear
  • Core strengthening
Complementary and Alternative Therapies
Orthotic or shoe modification to decrease pronation
Medication
First Line
  • NSAIDs
  • Analgesics
Surgery
Only after a documented trial of maximal nonoperative treatment has failed should posterior medial fascia release be considered.
Follow-up
Prognosis
  • Most cases respond well to nonoperative treatment.
  • Gradual return to activity can be expected.
  • Variation of the causative regimen of training and identification of training errors will help prevent recurrence.
Complications
Undiagnosed stress fracture can lead to complete fracture and displacement.
Miscellaneous
Codes
ICD9-CM
844.9 Shin splints
Patient Teaching
  • Identify training errors.
  • Emphasize the importance of modified activity followed by stretching and strengthening exercises.
  • Resumption of activity should be done gradually, below the level of the symptoms.
FAQ
Q: Do patients with shin splints need physical therapy?
A: Although shin splints usually are self-limiting with rest, identification of training errors, and gradual return to activity, physical therapy can be helpful. Physical therapy can use modalities to reduce the acute symptoms while identifying training errors, flexibility, and limb alignment issues. Concentric and eccentric strengthening of the lower extremity in addition to core strengthening may reduce the risk of recurrence.

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