Shin Splints

Shin splints are a common problem which cause pain in the lower leg. Shin splints can be broken into two basic categories;

Anterior Shin Splints -

Anterior shin splints are considered an excessive use syndrome of the tibialis anterior muscle and tendon. The symptoms of anterior shin splints take place at the origin of the tibialis anterior muscle and tendon (the origin of a muscle and tendon is where it begins and is anchored to the bone). In the case of anterior shin splints, the origins may be the tibia, or shin bone. Anterior shin splints are the most common form of shin splints.

Tendon affected tibialis anterior Tendon function deceleration of the foot in swing phase and heel contact Location of pain front of the shin and ankle

• Diagnosis of anterior shin splints is usually based upon the location and character of the symptoms.
• Diagnostic testing may include x-rays, bone reads or MRI studies to rule out tibial stress fractures.

We all recognize the fact that anterior shin splints are a mechanical problem, we are safe to assume that a mechanical option would be in order. The important thing to treating anterior shin splints is to change the functional length of the actual tibialis anterior muscle and tendon (biomechanical changes). The symptoms of inflammation may be taken care of concurrently, yet without treating the mechanical component of anterior shin splints, recurrence is likely.

• Decrease the length of stride.
• Getting shorter steps decreases the useful period of the tibialis anterior and subsequently reduces the pull of the muscle on the tibia.

Modified arch support to be able to decrease the functional length of the actual tibialis anterior. This can be accomplished by increasing the arch of an arch support or orthotic distally to reach under the first metatarsal as well as big bottom joint. Changes should be made slowly and incrementally. As you build up and also extend the arch, you are decreasing the functional length of the tibialis anterior.

• Addition to treating the mechanics of anterior shin splints, further care can be used to calm the inflammation connected with this condition.
• This will become increasingly important as the severity of the condition increases.
• Ice before and after activity helps.
• Anti-inflammatories or ultrasound treatments also help.
• As a last resort, rest is helpful but never a final solution.
• Rest can be as simple as a decrease in activity, a walking cast or even a cast with crutches.
• It is important to recognize that rest without treatment of the biomechanical origin of this condition will never be a final solution.

Posterior Shin Splints -

Posterior shin splints are seen less often than anterior shin splints, but are not one the a smaller amount, just as unpleasant. The oncoming of pain as well as the location vary just a bit;

Tendon affected tibialis posterior Tendon function assistance of the medial midfoot ( arch ) and plantarflexion of the foot at toe offLocation of soreness at the rear of the medial malleolus (inside ankle bone)

The posterior tibial muscle originates from the back of the tibia, deep to the calf muscle. As it descends the leg it narrows to become the rear tibial tendon. As the posterior tibial tendon descends the leg, it follows a path instantly at the rear of the actual posterior aspect of the medial malleolus (ankle bone)making an sudden turn to continue to the particular medial arch. In the arch of the foot, the posterior tibial tendon branches into nine different insertions in the bottom of the foot. Posterior shin splints tend to be a true form of tendonitis and occur in the body of the tibialis posterior tendon guiding the medial malleolus inside ankle bone).

To effectively handle any form of tendonitis, we must realize that tendonitis is an over-use condition. Therefore, effective treatment lies either in modifying the way the tendon functions alignment changes) or changing the activity that plays a part in overuse. We know that the function of the tibialis poster tendon is to support the arch. Subsequently we can support the function of the tibialis posterior tendon by supporting the arch with a rigid arch support. The tibialis posterior can also be assisted by raising the heel with a firm heel lift and by carrying out calf stretches to weaken the calf muscle. The calf muscle has a significant influence on the function of the posterior tibial tendons. For more information begin to see the 'additional information' tab on this page.

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Part of treating shin splints is treating the inflammation found in both anterior and posterior shin splints. Treatment of inflammation is essentially the same in either posterior or anterior tibial tendonitis as well as includes ice, medications, ultrasound or relaxation.

Nomenclature:

Functional amount of a tendons - each muscle and its' associated tendon have a normal range of excursion of length in which they are accustomed to working. This normal length is referred to as the functional length. That length of function.

Shin - refers to the lower leg, more specifically, the tibia or larger bone of the leg.

Anatomy:

Anterior shin splints -

Knowing the origin of the tibialis anterior muscle becomes important when trying to differentiate the numerous cause of shin pain. First, why don't we take a look at some simple anatomy. As we mentioned, the tibialis anterior muscle and tendon originate from the front of the tibia or shin bone. This origin begins just distal to the knee and continues halfway down the leg, consequently we can say that the origin of the tibialis anterior muscle may be the proximal half of the tibia. Also, the origin is not just on the front of the tibia, but actually tucked a little under the lateral or outside edge of the tibia.

Posterior Shin Splints -

The posterior tibial muscle originates from the back of the tibia, deep to the calf muscle. As it descends the leg it narrows to become the posterior tibial tendon. As the posterior tibial muscle descends the leg, it follows a path immediately behind the actual posterior aspect of the medial malleolus (ankle bone)making an abrupt turn to continue to the particular medial arch. In the arch of the foot, the posterior tibial tendon branches into nine different insertions in the bottom of the foot. Posterior shin splints tend to be a real form of tendonitis and occur in the body of the tibialis posterior tendon behind the medial malleolus inside ankle bone).

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Biomechanics:

Anterior shin splints -

Now Let's Chat Biomechanics

As we walk or run, the tibialis anterior has two functions. The very first occurs at heel contact once the tibialis anterior functions in order to slow the motion of the foot as it hits the ground. Without a tibialis anterior muscle as well as tendon, the foot would slap the floor. This slowing action is referred to as deceleration and contributes to the controlled gradual motion of the ankle to be able to which we are so accustomed. The second function of the tibialis anterior is to lift the foot during the swing phase of gait. Swing phase is the time scale when there is no weight on the foot following toe off and right before heel get in touch with. During swing phase, the tibialis anterior lifts the foot to prevent it from dragging on the ground.

Quite often the cause of anterior shin splints has ended striding. More than striding increases the normal functional period of the tibialis anterior. Essentially, much of the range of motion of a muscle and tendon has to do with the changes in its' overall length. In the case of the tibialis anterior, all of us know that at heel get in touch with, the muscle functions to decelerate the actual foot as it hits the floor. As the foot moves to hit the ground, the tibialis muscle and tendons lengthen.

So, if we increase the length of stride, the tibialis anterior muscle tissue and tendon increase a lot more. In the case of anterior shin splints, the tibialis anterior muscle and tendon can't keep up with the demands placed upon it and, as a result, starts to find new ways to gain length. Very often that additional length is gained by the muscle pulling away from it's origins. In the case of the tibialis anterior muscle and tendon, we call that anterior shin splints.

• We know that anterior shin splints are common in sportsmen, but let's utilize an illustration found in everyday life.
• Bridgit is a brand new postal worker.
• She's 5'2" tall and she is training for a walking mail route in her home town.
• Her mentor is Jim who has worked the route for a long time.
• Jim is 6'3" tall.
• Jim and Bridgit begin to work together walking the eight mile route daily.
• Bridgit really wants to get this new job, so she tries her hardest to be able to keep up with Jim despite the fact that she has a hard time.
• Jim is so much bigger, as well as to simply keep up, Bridgit has to over stride in order to compensate for their physical differences.
• By the end of the first week, Bridgit's in trouble.
• She has pain in the front of her shins.
• She has anterior shin splints.

Posterior Shin Splints -

The tibialis posterior muscle and tendon acts as the primary support of the medial arch. The tibialis posterior muscle and tendon also functions to plantarflex the base at toe off and assists the Achilles tendon in its' function to move all of us ahead.

• When we think of managing the symptoms of posterior shin splints, we need to find the function of the posterior tibial tendon (PT tendon).
• Many cases of posterior shin splints are caused by increased activities with no control of pronation.
• The full biomechanical definition of pronation is somewhat complex, but for our discussion, consider pronation to mean flattening of the arch.
• The middle of the stance and toe off phases of gait place a significant load on the rear tibial tendon.
• The PT tendon will attempt to maintain the normal top of the arch and aid in toe off, assisting the calf and Achilles tendon.
• If the loads applied to the particular PT improve faster than what the tendon can accomadate, tendonitis will result.
• The PT muscle is easily supported with a rigid arch support throughout mid stance phase of gait.
• Insert to the muscle can be decreased at toe off by extending the calf muscle on a regular basis.

Symptoms:

Anterior shin splints -

Earlier in this discussion we reviewed some anatomy and defined the origin of the tibialis anterior muscle and tendon on the anterior and antero-lateral aspect of the tibia. Anterior shin splint pain is very specific to this place.

• The early stages of anterior shin splints, pain is very similar to that of other forms of tendonitis.
• Sharp pain on the anterior lateral tibia will be significant upon the onset of an activity.
• As the activity advances, this goes away until the normal conclusion of the activity is reached, at which time the same pain returns.
• Advance cases of shin splints, in addition to the pain with the activity, the origin of the tibialis anterior becomes inflamed and cannot heal.
• This results in chronic pain from swelling at the origin of the tibialis anterior.

Posterior Shin Splints -

The signs and symptoms of posterior shin splints are uniquely more advanced than anterior shin splints. Rear shin splints are the result of inflammatory pain of the posterior tibial tendon. The symptoms of posterior tibial shin splints occur 8-10m cm proximal to probably the most distal tip of the medial malleolus (inside ankle bone). Swelling may occur but will be minor.

Posterior shin splints exhibit traditional tendonitis symptoms. In the early stages of posterior shin splints, pain is noted at the beginning of an activity and seems to 'warm up' over the first five minutes or so of the activity. In advanced cases, pain is constant and can be aggravated by any form of weight bearing.

Differential Diagnosis:

Stress fractures from the tibia present with pain similar to anterior shin splints.

Posterior Shin Splints -

Conditions that may resemble posterior shin splints include tarsal tunnel syndrome, tibial stress fractures, posterior tibial tendons rupture, flexor hallucis longus tendonitis, gout, osteoarthritis of the subtalar joint or a fracture of the posterior process of the actual talus.

About the author:Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.

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