Shin Splints


Shin Splints, Medial Tibial Stress Syndrome

  • See Also
  • Pathophysiology
  1. Tightness in Tibialis Posterior and Soleus Muscles predisposes to Shin Splints
  2. Tibial periostitis with anterior tibia micro-Fractures
  • Risk Factors
  1. Poor flexibility
  2. Over-pronation or increased internal tibial rotation
  3. Worn or improper shoes
  4. Running on Hard surfaces
  5. Early season hill training
  6. Increased training intensity, pace or distance
  7. Miserable Malalignment Syndrome
  • Signs
  1. Localized pain (and mild swelling) at middle to distal third of postero-medial tibia
  2. Pes Planus associated with over pronation
  • Differential Diagnosis
  • Imaging
  1. Tibia XRay
    1. Evaluate for Stress Fracture
  2. Tibia MRI
    1. Most accurate test for occult Stress Fracture (perform if high level of suspicion and negative XRay)
  • Management
  1. Calf Stretching
    1. Alphabet writing range of motion Exercises with foot
  2. Local measures and Analgesics
    1. NSAIDs
    2. Ice massage
    3. Transverse friction massage (TFM)
    4. Local Ultrasound with Phonophoresis
  3. Orthotics
    1. Cushioned anti-pronation inserts (CAPI)
    2. Sleeve, strapping, brace
  4. Relative rest
    1. Decrease training and avoid hills
    2. Consider cross training activities
    3. Limit activity to soft surfaces
  • Management
  • Algorithm based on severity
  1. Mild Shin Splints
    1. Implement above measures
  2. Moderate Shin Splints
    1. Implement above measures
    2. Replace Running with non-provocative activity
    3. Consider evaluation for Tibial Stress Fracture
  3. Severe Shin Splints
    1. Implement above measures
    2. Long air cast
    3. Evaluate for Tibial Stress Fracture
    4. No weight bearing sports until
      1. Two weeks of rest and
      2. Negative Hop Test