Stepping Into Better Health: Overcoming Shin Splints

Posted on Categories General Orthopedic

The spring months are always a favorite time to begin reclaiming the mileage enjoyed during last year’s running season. However, as the mileage and speed begin to return so can injuries from chronic use. One of the more common injuries during this time of year presents as recurrent pain along the inside or front of the leg, particularly along the lower half of the tibia. Although there are several specific possible causes, this is commonly referred to as “shin splints.”

Shin splints are classically defined as inflammation of the membrane (periosteum) that covers the shinbone (tibia). It presents as pain and tenderness, with possible swelling on the inner side of the lower leg—especially the lower half of the lower leg. However, if this pain continues for several days, it has likely advanced to tendonitis and will require your attention for its resolution.

The tibialis posterior muscle resides against the back of the tibia within the deepest compartment of your leg. Its tendon runs down the inside of your leg around your medial malleolus and inserts at the midfoot. It is the major inverter of your foot and is opposed by a similar muscle tendon on the lateral leg that, together, allows your foot to adapt and conform to any surface on which you’re walking.

With hyperpronation (the foot rolling too far inward), a strain can be placed upon this tendon and generate pain along the inside of your leg. This may be accompanied by periosteal inflammation or even contribute to its progression.

Symptoms are most commonly found as the tendon becomes tender several inches above your ankle, however this pain may present anywhere along its course. Over time, what began as inflammation around the tendon (peritendonitis), can advance to inflammation within the tendon, (tendonitis). If untreated, this can advance to a longitudinal split within the tendon fibers and result in a full tendon rupture—resulting in structural collapse of the foot.

Most fitness-minded individuals will not allow this to go this far; however, many factors within our lives can influence when we initiate treatment: busy lifestyles, a physically demanding job, family obligations, etc.

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Symptoms

  • Symptom onset is usually gradual.
  • There is pain, tenderness and possibly swelling on the inner side of the shin, particularly the lower half, approaching the ankle.
  • Pain can be triggered when the toes or ankle are bent down, or the foot bent in; with or without resistance.
  • Pain may be initially relieved with rest, but return with running/jumping. However when allowed to deteriorate, the pain may be felt continuously.
  • With deterioration, pain may be specific over the site of tendonitis or tear.

What You Can Do

  • Modify activity:
    • Consider lowering mileage, or slowing speed if you are running.
    • Switch to lower impact activity including elliptical training, bicycling, or swimming.
    • Avoid treadmills as these will accentuate hyperpronation.
    • RICE (Rest, Ice, Compression, Elevation)
      • Rest-is a major component of repairing your injury. Placing continual strain on the injury will likely result in longer recovery and time away from your favorite activity.
      • Ice reduces swelling through the initial 72 hours of the inflammation following an injury. The key however is to use it only 15 to 20 minutes per hour. Exceeding the recommended time could actually delay the healing time.
    • Compression helps limit and reduce swelling, too much swelling can cause excessive pain and slow down blood flow through vessel restriction. Compression stockings can help manage the swelling. The fit should be snug but still allow for expansion of the muscle.
    • Elevation after activity can relieve temporary swelling and pain. Place the foot above the heart to gain maximum benefit. By default, this will require you to rest, which is serving two methods of treatment with one action.
    • Find the right shoe for your body weight, anticipated mileage and foot type. Motion- control shoes can offer resistance to hyperpronation. Over-the-counter inserts designed to control motion can work well in the appropriate shoe.

What Your Doctor Can Do

  • Depending on the nature and severity of your condition, your doctor might recommend or prescribe anti-inflammatories, immobilization, rest or even non-weight bearing status while your body heals. Physical therapy may be used on an outpatient basis to re-establish lost flexibility, strength or even equilibrium proprioception.
  • Custom orthotics are a mainstay of treating this condition, and do so by treating the biomechanical cause. This often requires a “functional orthotic” that corrects the improper alignment as opposed to an “accommodative orthotic” that simply supports the foot in its current position. Early intervention with functional orthotics can permanently resolve shin splints, avoid the need for surgery, and allow your body to perform at peak efficiency during athletic activity.
  • An X-ray or MRI may be necessary to determine any underlying bone or soft-tissue injury accompanying your injury.
  • In the event of a tendon tear, you may need surgery to repair the damaged structure(s).Recovery
  • Mild to moderate tendinitis can take four to six weeks to heal—provided adequate rest is employed. Continued activity may turn an acute injury to a chronic condition requiring further treatment and time. If surgery is required, an athlete can usually return to activity within 12 to14 weeks and will often require physical therapy to regain strength and flexibility.

Dr. Randall Kline is a board-certified podiatrist specializing in injury, wound and diseases of the foot and lower leg. Contact Allied Bone and Joint at (574) 247-4667 or visit AlliedBoneandJoint.com for more information.

This article was originally published in RacePlayMichianaRacePlayMichiana is the premier local source for all news regarding sports and fitness in the Michiana area. RPM is produced in print and online on a bi-monthly basis.