SHIN SPLINTS

A shin splint is pain resulting from damage to the muscles along the shin. The usual cause is long-standing, repeated stress to the lower leg. Two groups of muscles in the shin are susceptible to shin splints. Location of pain depends on which group is affected.

Anterolateral shin splints are the result from a natural imbalance in the size of opposing muscles. The shin muscles pull the foot up, and the larger and much stronger calf muscles pull the foot down each time the heel touches the ground during walking or running. The calf muscles exert so much force that they can injure the shin muscles. The main symptom is pain along the front and outside of the shin. At first, the pain is felt only immediately after the heel strikes the ground during running, walking or similar activities. Continued activity tends to result in constant symptoms. Healing this condition requires cessation of the activity involved. Calf-stretching exercises can be helpful. Once healed, the shin muscles should be strengthened to avoid a return of symptoms when active.

Posteromedial shin splints affect the muscles in the back and inner parts of the shin, which are responsible for the lifting of the heel just before the toes push off. This type often results from running on banked tracks or crowned roads and can be worsened by rolling on to the outside of the feet (pronation) excessively or by wearing running shoes that do not adequately prevent such rolling. The pain produced by this type usually starts along the inside of the lower leg, about 1 to 8 inches above the ankle and worsens when the runner rises up on the toes or rolls the ankles in. Continued running causes the pain to move forward, affecting the inner aspect of the ankle and may move up the shin to within 2 to 4 inches of the knee. The severity of the pain increases as the shin splint progresses. At first, only the muscle tendons are inflamed and painful, but if the person keeps running, the muscles themselves can be affected. Eventually, tension on the inflamed tendon can actually pull it from it's attachment to bone, causing bleeding and further inflammation.

Treatment

The primary treatment is to switch from running to a less traumatic activity, until running is no longer painful. Sturdy running shoes and custom fabricated orthotics can keep the foot from rolling onto the outside excessively. Avoiding running on banks or uneven surfaces can help prevent shin splints from returning. Exercises to strengthen the interior muscles are useful.