The lower leg bone consists of the larger tibia bone and the thinner outer bone called the fibula. Shin Splints typically occur in those individuals whose arch excessively collapses to the ground during running and/or jumping activities. This causes the muscles of the lower leg, which are attached along the tibia bone, to pull downward away from this bone as the arch collapses and the foot flattens. Anatomically, these leg muscles start along the side and the back of the tibia leg bone, course down the leg, and insert into the undersurface of the arch. The more the arch collapses, the more pulling of the muscles downward off of the shin bone. This is magnified when the foot toes outward while sprinting or running due to the increase in length between the proximal origin attachment on the leg to the distal insertion attachment of each muscle and tendon to the bottom of the foot and toes.
Often times, when muscles pull from their attachment along the leg bone, it causes irritation and inflammation of the lining of the bone called periostitis. Sometimes, there is strain to the muscle itself rather than its tendon’s attachment; this is called myositis. Sometimes, the tendons which are at the end of the muscle, get strained; this is called tendonitis. Shin Splints are a term for any of the pains along the leg. It is worsened by a preexisting structural deficiency such as flat feet or out toed gait. Shin splints may also occur from the repetitive stress of running or jumping activities, particularly at the beginning of the season. It is also common when advancing one's activity level somewhat abruptly, before one's muscle are sufficiently strengthened or flexible to keep up with the demand placed upon them. Shin splints, typically go away after a few days of rest; however, they are bound to recur if the cause of the problem is not corrected.
Stress Fractures of the leg are caused from stress. The most common reasons occur due to collapsing of the arch to the ground (over-pronation) more commonly seen in the flat footed individual, but can also occur in the flexible high arched foot that collapses upon impact. This is greatly exemplified in running and jumping activities, particularly in sports that include a strong foot push-off such as in field or court sports and sprinting activities. When the amount of stress is too much for the bone to handle, a microfracture occurs. Stress may also occur to one’s bones due to lack of shock absorption. Often this occurs in those with high arches. If the foot does not partially collapse, then shock is not properly attenuated by the muscles of the foot or leg and a small bone fracture may occur. This may also occur in an individual with extremely tight calves or hamstrings. In this situation, tight muscles can inhibit the tibia and fibula bones from pistoning, which would limit the muscles between the bones from absorbing and dissipating shock.
In our office, treatments for these problems start with a history to check dietary contributions, hormonal influences and bone quality. We perform a thorough examination of one's lower extremity structure. We provide in office x-rays to help make a proper definitive diagnosis. Often times, we will watch the athlete run. If necessary, corrective exercises to improve gait or sport activity are given. Flexibility exercises and/or strengthening exercises are often recommended. If there is an intrinsic foot fault such as a flat foot or high arched foot structure, then flexible medical grade orthotics are fabricated specific to one's foot and body structure. It is of utmost importance to understand that orthotics for flat feet and high arch feet type are significantly different.
Symptoms of Exertional Compartment Syndrome including tightness, tingling, or burning pain during sports activities and are addressed in a separate topic on this website. If you or someone you know suffer from shin splints, stress fractures or Exertional Compartment Syndrome of the leg please refer them to our office.
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Written by Richard T. Braver, DPM, FACFAS