Shin pain refers to pain in the region caused by one or more reasons by three conditions.
These conditions are:
- Tenoperiostitis: inflammation occurring where tendons attach to a bone
- Compartment Syndrome: exercise-induced muscle ‘swelling’ and an increase in pressure in the compartments of the lower leg
- Stress Fractures of the Shin Bone: incomplete fracture or crack within the shin bone (tibia)
It is important to note that two or all three of these conditions can co-exist together. The podiatrist must first determine what conditions are present and sometimes x-rays and bone scans may be needed. Following diagnosis, appropriate treatment can be implemented.
Pain varies according to the condition(s) present, however it is usually localized at the point in the above diagram.
There are a number or reasons why shin pain occurs:
- recent change in training (including frequency, duration, intensity, training surfaces, reduced recovery)
- tight calves and other muscles
- excessive over-pronation (flatterning of the feet) and over-supination (high arch feet)
- inappropriate footwear
Initially shin pain is treated conservatively by addressing the above causes. This is achieved by stopping the above training errors. Poor foot posture and function which leads to muscle overuse and fatigue are corrected via customized prescription orthoses and appropriate footwear. Tight, weak muscles will be identified and a stretching, strengthening and massage program will be instituted with referral to a physiotherapist necessary. A referral to a physiotherapist may be necessary.
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TENOPERIOSTITIS
Tenoperiostitis is inflammation occurring where tendons (usually the deep calf muscles) attach to a bone (usually the shin bone – the tibia). The tendons attach via a layer of connective tissue called periosteum and this is the structure which forms an inflammatory response.
Symptoms associated with plantar fasciitis include:
- sharp pain on the inside of the shin, which is worse in the morning and after exercise
- tender to touch at the site of the inside shin
There are a number or reasons why constant tearing of the muscles tendons away from the shin bone occurs leading to inflammation of the periosteum:
- Excessive over-pronation (flatterning of feet)
- Recent weight gain
- Increased activity levels
- Tight Calves
- Changes of footwear/Poor footwear
Treatment initially involves reducing the inflammation conservatively by icing, stretching, massage and physiotherapy. Training errors must also be addressed. The next step is to eliminate the cause of the traction by the tendons due to poor foot posture and function. This is achieved by customized prescription orthoses and appropriate footwear.
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TIBIAL STRESS FRACTURE
A tibial stress fracture is an incomplete fracture or crack within the shin bone.
Symptoms associated with plantar fasciitis include:
- constant or increasing sharp localized pain on the inside of the shin
- may be increased in the morning and with exercise
- occasional night pain
- tender on the bony margin
There are a number or reasons why constant repetitive stress occurs in the shin bone leading to a stress fracture:
- sudden change in training (including frequency, duration, intensity, training surfaces and footwear).
- excessive over-supination (high arch feet) or over-pronation (flatterning of feet)
- menstrual disturbances
- poor footwear
Treatment initially involves reducing the inflammation conservatively by weightbearing rest of 4-8 weeks, icing, stretching, massage and physiotherapy. Training errors must also be addressed. The next step is to increase shock absorption with customized prescription orthoses and appropriate footwear.
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COMPARTMENT SYNDROME
Compartment Syndrome is exercise-induced muscle ‘swelling’ and an increase in pressure in the compartments of the lower leg. Compartments within the lower leg are like sausage skins, which hold soft tissue structures like muscle, blood vessels and nerves. With exercise, most soft tissue structures increase in size due to more circulation. This stretches and places pressure on the sausage-skin like sleeves and nerves and blood vessels within the compartment, thus causing pain. The two most common compartments that are effected are the front compartment and the deep back compartment.
Symptoms associated with compartment syndrome include:
- cramping, burning, bursting pain during exercise and does not go away until you lower your exercise intensity or stop exercising
- feeling of tightness and fullness
- feeling of numbness and tingling
- pain upon stretching of the region
- pain and weakness upon certain movements
There are a number or reasons why pain occurs with compartment swelling:
- Limited compartment volume
- Poor expansion of the compartment
- High compartment content (usually large muscles)
- Increased inflammation due to overuse of muscles
- Overtraining
Measurement of compartment pressure may be necessary by a sports physician. Usual pressures are 4-10 mmHg during rest and 30 mmHg during activity. Using a special device, if there the pressure is over 20 mmHg five minutes after exercise, compartment syndrome is present.
Treatment initially involves reducing the inflammation conservatively by icing, stretching, massage and physiotherapy. Training errors, most importantly running surface and footwear must be addressed. The next step is to decrease inflammation due to muscle overuse that may increases pressure within the compartment. This muscle overuse is because of poor foot posture and function and corrected with customized prescription orthoses. However, it has been found that total resolution of pain can only be achieved by a surgical release of the compartment. If pain levels reduce significantly, a full return to activity is possible.
