- Discussion:
- a complex syndrome characterized by exercise induced pain in mid leg;
- contributing factors include varus hindfoot, excessive forefoot pronation, genu valgum, excessive femoral anteversion, & external tibial torsion;
- may encompasses a wide spectrum of disorders including periostitis near origin of soleus & FDL muscle origins and stress fractures;
- probably not relate to pathology of the origin of the tibialis posterior;
- involved in the etiology of shin splints is the normal pronation of the forefoot during stance phase;
- stance phase pronation allows for shock absorption;
- excessive or unbalanced pronation may be a cause of shin splints;
- shin splints are rare w/ age < 15 years;
- differential diagnosis:
- stress fracture
- chronic compartment syndrome
- sciatica
- DVT
- popliteal artery entrapment
- muscle strain
- tumor
- infection
- Exam:
- tenderness is localized to posteromedial border of tibia in mid to distal third regions;
- tenderness is usually more localized with stress fractures;
- Radiographs: usually normal in periostitis
- Bone Scan:
- periostitis appears as linear streaking over posteromedial aspect of the tibia;
- stress fractures differ in that uptake is localized;
- Treatment:
- rest is the key to treatment of stress fractures and periostitis'
- stress fractures may take up to 12 weeks to heal completely;
- casting may be indicated;
- fasciotomy of the posterior superior compartment may be indicated in severe cases
The medial tibial stress syndrome. A cause of shin splints.
Medial Tibial Stress Syndrome. The Location of Muscles in the Leg in Relation to Symptoms.
Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome