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          Leg

Shin Pain/”Splints”

 

Are basically a stress reaction from overuse or poor walking/running mechanics in the lower 2/3 of the leg. It is characterised by pain, stiffness and heaviness of the leg at the beginning of exercise. A positive diagnosis is obtained by the podiatrist with simple palpation of the anterior +/or medial tibia, with the client experiencing severe pain. Post activity it can be even more painful.

The main reasons for the pain are the pull on the tibia from the extensor hallucis and anterior tibial muscles and tibialis posterior. All are decelerators of pronation (the rolling in motion of the foot).

Most often activities such as downhill/uphill running, uneven surface activity or hard surface activity combine with pronation foot types prove to be the pathogenesis responsible. The reason such shin splints arise is the over working of musculature in the various compartments of the leg, usually the anterior/medial compartments. Such overworking results in the muscles fatiguing, pulling harder on their various attachments to the tibia resulting in inflammation, which is in fact shin splints.

Such shin splints are unable to be detected cleanly on X-rays within the first 2-3 years of the initial pain associated with the condition. They are detected on bone scans as focal 'hot spots' (darkened areas on a light background) in the bone phase.The first stage of medial /anterior shin pain is irritation to the periosteum and attchment of the tib anterior and posterior to the tibia. This is referred to a “stress reaction” and often detected on a bone scan in the blood pool phase.

Treatment for the different types varies greatly.

Compartment Syndrome

The muscles in the various leg compartments are held in such divisions by relatively non stretchable fascia. During exercise the muscles in the leg can expand by up to 20-25%. Any extreme overuse of these muscles through poor exercise practices and/or fatigue can lead to an increase in inflammation within the overworked compartment without comparative expansion of the non-extensible fascia.

Compartment syndrome is characterised by the lower leg and foot feeling cold and numb with pain and tingling generally evident. Pain is generally decreased by inactivity and/or massage of the leg, allowing the pressure to decrease and the fascia becoming more flexible. Unfortunately, this only provides temporary relief. Unless the mechanics of the foot and/or shoewear and training program are addressed the pain will continue even after a period of inactivity.

  • Poor training
  • Poor foot mechanics
  • Muscle fatigue
  • Compartment pressure
  • Increase pull of increases muscle on bone
  • Ischaemic pressure
  • Focal areas of on nerves/arteries inflammation or 'hot spots'
  • Pain, tingling, numbness
  • Painful on palpation cold, heavy feeling stiff and heavy
  • Compartment Syndrome
  • Shin Splints