Shin pain can have a number of causes.
The term “shin splints” refers to pain in the tendons of the leg that control the movement of the foot. Pain can be in the tendons, the muscles that form the tendons or, occasionally, in the bones to which the muscles attach.
There are three types of shin splints: medial shin splints, sometimes referred to as medial tibial stress syndrome, anterior shin splints and lateral shin splints. Overuse of specific muscles is the main cause. Why are specific muscles overused? The reason is that patients can have biomechanical imbalances that make certain muscles work harder during physical activity.
1) Medial shin splints often refer to posterior tibial tendinitis. The posterior tibial muscle and tendon are attached to the inside of the tibia, the main bone of the leg. Patients who overpronate, who have feet that roll in and flatten out will overuse the posterior tibial muscle and tendon. The posterior tibial tendon and muscle are responsible for lifting up on the arch of the foot and supinating (rolling out) the foot. Dr. Ed Davis, pediatric podiatrist in San Antonio has treated many children for this issue. It is common to see parents try a number of different treatments that only provide temporary relief before seeing us. Once the cause of the problem is identified and treated, the problem often resolves in a few weeks. Overpronation can be treated, depending on the severity, with shoegear changes, foot orthotics and occasionally bracing.
2) Anterior shin splints generally refer to anterior tibial tendinitis. The tibialis anterior muscle attaches to the front of the tibia and is responsible for lifting the foot up (dorsiflexion). If a child has a tight heel cord or Achilles tendon, then the tibialis anterior muscle will be overworked and potentially painful. Again, the cause of the problem need be identified and treated to obtain lasting relief. A tight heel cord is also called functional equinus and can, in most cases, be resolved by a type of physical therapy called manual therapy.
3) Lateral shin splints cause pain on the outside of the leg. This is generally caused by overuse of the peroneal muscles. Those muscles function to roll the foot inward or prevent it from rolling outward too much leading to ankle sprains. This is more common in patients who have high arches, weak ankles or, occasionally, neuromuscular diseases. Use of orthotics or possibly lateral shoe wedges can be effective treatments.
If shin splints are left untreated, they can progress, at times, to more serious issues:
1) Stress fractures: Stress fractures are hairline fractures that occur from long term or repetitive stress on a bone. Any of the tendons mentioned above can, if overly strained for a long period of time, lead to hairline fractures at their attachments to bone. Medial shin splints are the most common cause.
2) Compartment syndrome: The muscles of the leg are wrapped in a thin fibrous membrane or fascia which service to contain and support the muscles. Overuse of muscles can cause them to swell. Excess swelling may be trapped in the fascial compartments causing pain, and occasionally, an emergency situation when circulation is restricted.
Dr. Davis encourages parents to find the cause of shin splints in children by getting a thorough biomechanical examination.
