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