shin splints; anterior tibial syndrome; medial tibial stress syndrome

Etiology

• periostitis
• tibial stress fracture
• risk factors
  • pes planus
  • excessive pronation
  • increase in training intensity

Clinical manifestations

• pain along the medial, distal 2/3 of the tibia
  • initially painful with running & after exercise
  • progressively becomes painful at rest
  • pain during exercise, improves with rest, & is associated
• tenderness of distal medial tibia
  • tenderness over the distal 2/3 of posterior-medial tibia
• tenderness of periosteal attachment of posterior tibial or soleus muscle

Radiology

• radiograph is normal unless a stress fracture is present
• bone scan may demonstrate stress fracture in 2-3 weeks
• bone densitometry for female runners with amenorrhea & low BMI

Differential diagnosis

• stress fracture of distal 1/3 of tibia
• delayed-onset muscle soreness
  • muscle pain (mylagias) that develops 24-48 hours after exercise
  • weakness, tenderness, stiffness & swelling may be noted
  • pain peaks 1-3 days after inciting activity with resolution in 7 days
• tibialis anterior muscle strain
  • pain at the time of injury or soon ater
  • pain localized to tibialis anterior muscle

Management

• non-steroidal anti-inflammatory drugs (NSAIDs)
• rest from weight-bearing exercise
• ice massage to painful area for 15 minutes several times per day
• full leg air splint & a brief period of restricted weight bearing if pain interferes with activities of daily living
• gait evaluation by a biomechanist
• advance running mileage slowly after control of pain

More general terms

• leg pain

Additional terms

• stress fracture (fatigue fracture)