Shin Pain and shin splints are often described as a “Bursting or dull throbbing along the front of the shin that is aggravated by walking or running and that settles as the person warms up into their activity”.
There are 3 main causes of shin splints:
Muscle and/or Bone Pain
This can be an acute injury or delayed onset muscle soreness (DOMS). The pain is caused by any activity that involves springing off the toes such as running, jumping, and sometimes even casual walking. Untreated shin splints can lead to a stress reaction mid-shaft in the tibia, which can eventually lead to a stress fracture. A stress fracture can be diagnosed by your podiatrist with x-ray but more ideally a bone scan or an MRI. Stress fractures take much longer to heal than stress reactions.
Another problem causing anterior shin splints is chronic compartment syndrome (CCS). This can be a serious problem that can lead to significant loss of function in the lower leg. CCS occurs when swelling within the muscle’s envelope (or fascia) in the leg constricts blood flow. This restricts oxygen and causes more swelling and generates more pain in a regressing cycle. In severe cases this can result in acute compartment syndrome (ACS) which requires emergency surgery to reduce the compartment pressure and prevent muscle death from loss of adequate blood flow.
Pes Planus or ‘flat feet’ is the most common cause of Medial Tibial Stress Syndrome or more commonly medial (towards the midline of the body) shin splints. Flat feet causes the posterior tibialis and other muscles of the shin to become overused and inflamed. Tight calves can increase this use also. The more the muscle is overused, the weaker and more inflamed it becomes. The best treatment for flat feet is to reduce the strain on them with orthotics and good footwear. Once the pain reduces the muscles can then be rehabilitated and strengthened. This combination of treatment gives the patient much less chance of the pain reoccurring.
Pes Cavus or feet with high arches can also cause shin splints. Feet with high arches tend to dissipate shock less effectively. This results in more strain on the muscles of the ankle and lower leg when the heel strikes the ground during activity. Orthotics inserted in shoes can help improve shock distribution and encourage healthy pronation of the foot if it is required.