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The lay term 'shin splint' is a generalized description of lower leg pain. Most causes of shin splints develop from overstress or inappropriate sports training, which are easily treated with conservative care.
Evaluation of lower extremity biomechanics is an important part of care, since shock-absorbing orthotic support is often necessary. Factors that predispose to shin splint development include: excessive pronation, pes planus, pes cavus, tarsal coalition, leg-length discrepancy and muscle imbalance.
What to Look For
Shin splints are muscle injuries that develop insidiously in one or both lower legs. The pain is usually described as an "aching soreness" that has been getting worse and is particularly noticeable when walking. This is an overuse condition that develops secondary to repetitive strain at the muscle insertion - either in the very active athlete or in a patient who has started or increased a new walking or jogging routine. Therefore, a careful history of recent weight-bearing exercise habits is vital.
The involved leg is tender to palpation along the muscle insertions in the middle or lower third of the tibia, along primarily either the anterolateral or the posteromedial aspect. Manual testing finds mild to moderate weakness of the involved muscles, and the isometric testing often causes increased pain of the muscle. There are normally no sensory or reflex changes, and no significant asymmetry in muscle mass.
There are two major types of shin splints which are differentiated by location and involved muscles. The underlying biomechanical abnormalities (and therefore the type of orthotic support needed) are also quite different.
Anterolateral. The shin splint that affects primarily the anterior and lateral aspect of the leg involves the tibialis anterior, extensor hallucis longus and extensor digitorum longus muscles. Since these muscles decelerate the foot and absorb the shock stress at heel strike, they are placed under increased demand when there is excessive running on hard or downhill surfaces or when the shoe has lost its shock-absorbing qualities. In addition to biomechanical support and a better heel pad, good forefoot cushioning is also recommended for the anterolateral type of shin splint.
Posteromedial. When there is excessive pronation, the muscles that try to stabilize the ankle become overstrained and cause shin splints. These are the muscles along the posterior and medial aspect of the lower leg, including the tibialis posterior, flexor hallucis longus, and flexor digitorum longus muscles. Occasionally the soleus muscle is implicated. Arch support and a medial pronation wedge under the calcaneus are needed to reduce the stress on these muscles. Shock absorption is helpful, but supporting the foot and ankle biomechanics is most important.
Back to Full Activity
A patient who reports pain in the lower leg following exercise or similar activity is often experiencing shin splints. Differentiation between anteromedial and posterolateral helps to determine the patient's treatment and orthotic support needs. Conservative care, including isotonic exercises and flexible, custom-made orthotics for biomechanical imbalances will allow a rapid return to full activities. To prevent recurrences, athletes should be educated to replace their shoes before they are obviously broken down, and to avoid abrupt changes in training.
When patients with shin splints are treated at Advanced Healthcare by Dr. Pisarek, they also have the opportunity to have their posture and gait analyzed. Often, small changes in biomechanical function can significantly improve athletic performance.
Call Dr. Pisarek today for an assessment of your shin splints and let him get you started on your road to recovery!
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.