Shin splints is an umbrella name, not a diagnosis for pain along and around the shin bone known as the tibia. The proper name for this condition is ‘tibial stress syndrome’ and is a result of overload or a traumatic blow to the leg.
Common Tibial Stress syndrome differential diagnoses:
TIBIALIS POSTERIOR DYSFUNCTION:
Occurs due to overloading of the muscle and tendon due to repetitive micro-trauma caused by running or walking in unstable shoes. This causes the foot to roll in (pronate) excessively and makes it harder for this muscle to make the foot roll out (resupinate) during the toe off period of walking. Pain can be felt under the arch of the foot or the inside of the tibia on the lower limb.
Symptoms: Pain underneath your arch where the tendon of the muscle inserts into the navicular as well as pain at the tendo-muscular junction (joint between the muscle and tendon) and along the muscle. As the injury progresses pain will be felt around the medial malleolus of the tibia and will follow the course of the tendon.
This condition is commonly misdiagnosed due to the tibial nerve which runs the same course. Secondary injuries or pain are also frequently associated with this injury including pain around the Achilles and plantar fascia.
There are 3 different peroneal muscles including peroneus longus, brevis and tertius. These muscles are commonly injured with rolling out (lateral) ankle sprains but can also occur due to overload caused by unstable shoes or shoes that are too supportive. Muscle belly pain can be felt on the outside part of the fibula with the pain caused by peroneus longus presenting higher than that of peroneus brevis. Problems with peroneus longus are also generally associated with cuboid pain which occurs on the bottom outside part of the foot. Problems with these muscles are generally easily diagnosed and treated.
Symptoms: Localised pain along the muscle and tendon which is generally only present during and after activity depending on the severity of the injury. The tendon may also be stiff in the mornings and take time to warm-up.
Note: Foot pain can be present on the outside of your foot or ankle.
SHIN STRESS FRACTURES (TIBIAL STRESS FRACTURES):
This is a hard injury to diagnose and treat. It is also very hard to pick up on x-ray and usually needs further diagnostic testing such as bone scans to look for abnormalities.
Symptoms: Occurs due to long periods of repetitive trauma (running) with a gradual onset of pain. Swelling may be present and pain is localized to the specific area along the bone.
This is another injury which is hard to diagnose and is often misdiagnosed as tibialis posterior stress syndrome. This injury occurs due to an increased amount of pressure within the muscles compartment. This is caused by a tightening of the sheath surrounding a muscle and can cause a decrease in blood flow and tissue perfusion which leads to pain (ischemic pain).
Symptoms: Pain occurs generally 10-15minutes into activity when pressure increases in the sheath of the muscle. As there are different compartments of muscle in the lower leg, the location of the pain can differ. This can present as aching leg or foot pain that can throb as the muscle desperately requires blood flow.
What can The Podiatrist do for your shin pain?
Through verified tests and our experienced assessment skills we work out the cause of your shin pain and work on a suitable treatment programme.
Treatment: Treatment of shin pain varies on the stage of healing and shin splint symptoms
- Tibial and peroneal pain is often treated with strapping, massage and strengthening
- Changing the mechanics of muscle activation and reducing muscle workload through orthotics
Stress fractures and compartment syndrome are generally treated on a case to case basis dependent on the severity of the injury. These are complex injuries in which we work alongside other professions like sports medicine doctors and physiotherapists.