Howard E. Friedman DPM
(Published in the NY/NJ Trail Conference publication Trail Walker, Spring 2015 issue)
Shin splints are common among cross country runners and military recruits during basic training. Both groups are putting a high impact repetitive load on their legs which they might not be used to doing. And, the same is true for a backpacker, hiker or trail runner ramping up her daily mileage.
The term “shin splints” is used in the vernacular to describe any exercise induced pain occuring below the knee and above the ankle. It usually is used to describe pain along the “shin” bone but some use the term to describe muscular pain in the lower leg as well. In fact, the term is slowly being replaced with medial tibial stress syndrome. But even this term is not wholly descriptive enough.
Simply put, however, shin splints can be divided neatly into a problem of the tibia bone or a problem of the soft tissue attached to that bone. And, further more, the shin splint may affect the ‘inside’ of the lower leg, that is, that area of the leg that faces the other leg, or, it can affect the outer part of the leg.
Shin Splint- Bone Pain
If a patient can point with one finger to an area of the leg that is particularly painful especially with a high impact activity like running, chances are that the pain is related to a repetitive trauma of the tibia bone itself. This pain can be an actual stress fracture (incomplete fracture) of the tibia or a stress reaction of the bone that will lead to an actual stress fracture if no precautions are taken. Most stress or pre-stress injuries to the tibial occur on the ‘inside’ of the leg bone but it can occur on the outside area as well.
Shin Splint- Soft Tissue Pain
If the patient complains of pain along a length of the lower leg, say, several inches long, most likely the shin splint is the result of either a micro tear of the muscle attachment to the leg bone itself, or, less likely, from a swelling of the muscles in the leg. If the pain is steadily worsening with no improvement, the patient may likely benefit from urgent surgery to release the pressure in the leg and help prevent further tissue damage. Fortunately this scenario is less common.
Whether the pain is ‘bone’ pain or ‘soft tissue’ pain, the treatment is similar. First, decrease or stop your physical activity until the pain resolves. Do not exercise through the pain. If the case of a pre-stress fracture of the tibia, ignoring the pain can result in a fracture.
Elevate the leg at rest and apply a cool compress or ice pack to the painful area for 5-10 minutes several times a day if possible. An oral anti-inflammatory pill taken regularly for a few days can be helpful as well as wrapping the lower leg with a wide ace wrap or neoprene sleeve.
Check Your Shoes
If the patient’s shoes are worn down significantly on one side, they should be replaced. If the patient has a significant flat foot or high arch foot, he or shoe may benefit from an arch support placed in the shoes. And, minimize any walking in unsupported foot wear, even at home, until the condition resolves.