Shin Splints

What are shin splints?

Shin Splints (Medial Tibial Stress Syndrome) is a condition characterised by damage and inflammation of the connective tissue joining muscles to the inner shin bone (tibia).

There are several muscles which lie at the back of your lower leg and are collectively known as the calf muscles. Several of these muscles lie deep within the calf (tibialis posterior, flexor digitorum longus, flexor hallicus longus and soleus) and attach to the inner border of the shin bone (tibia). The connective tissue responsible for attaching these muscles to the tibia is known as the tenoperiosteum. Every time the calf contracts, it pulls on the tenoperiosteum. When this tension is too forceful or repetitive, damage to the tenoperiosteum occurs. This results in inflammation and pain and is known as medial tibial stress syndrome– commonly referred to as shin splints.

Medial tibial stress syndrome can sometimes occur in combination with other pathologies that cause shin pain such as compartment syndrome and tibial stress fractures.

N.B. Medial tibial stress syndrome has only recently fallen into the catergory of shin splints, the main conditions that fall into this catergory are; stress fracture, myositis, periositis, tendinotis, compartment syndrome, fasciitis and ischaemic disorders.

Causes of shin splints

Shin splints most commonly occur due to repetitive or prolonged activities placing strain on the tenoperiosteum. This typically occurs due to excessive walking, running or jumping activities (such as an increase in physical exercise) and is often seen in runners and footballers. It frequently occurs in combination with calf muscle tightness or other biomechanical abnormalities, such as excessive pronation or supination (high arch), or in those who consistently wear inappropriate footwear. Athletes more commonly develop this condition early in the season following a period of reduced activity (deconditioning) and when training surfaces are generally harder.

Signs and symptoms of shin splints

Patients with shin splints typically experience pain along the inner border of the shin. In less severe cases, patients may only experience an ache or stiffness along the inner aspect of the shin that increases with rest (typically at night or first thing in the morning) following activities which place stress on the tenoperiosteum. These activities typically include excessive walking, running (especially up hills, on uneven surfaces or in poor footwear), jumping and general weight bearing activity.

The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp, although this may also reduce to some extent as the patient warms up.

Patients with this condition typically experience pain on firmly touching the inner border of the shin bone, particularly along the lower third of the bone. Areas of muscle tightness, thickening or lumps may also be felt in the area of pain. In severe cases, swelling, redness and warmth may also be present.

Prognosis of shin splints

Most patients with this condition heal well with appropriate treatment. Recovery time may range from a few weeks to many months depending on the severity of injury, quality of treatment and length of time the injury has been present for. Patients with shin splints that have been present for months may require a considerable period of treatment associated with reduced activity before full recovery occurs.

Contributing factors to the development of shin splints

There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected. Some of these factors include:

  • Excessive training or activity
  • Poor foot posture
  • Inappropriate footwear
  • Inadequate warm-up
  • Training on hard or inappropriate surfaces
  • Muscle weakness (especially the calf muscles)
  • Tightness in specific joints (such as the ankle)
  • Tightness in specific muscles (especially the calfs)
  • Poor lower limb biomechanics

Shin Splints Treatment

It is important to highlight that the best treatment for shin splints is treating the cause, rather than the symptoms, as previously discussed there has been a lot of research conducted which shows a rolled in foot/ over pronated foot or high arch foot will cause shin splints. By changing and optimizing foot and leg biomehcanics, we can treat the condition of shin splints. There are ways of dealing with the pain in-between time which include;

  • Deep tissue massage (particularly to the calf muscles)
  • Joint mobilization
  • Taping
  • Orthotics
  • Biomechanical correction
  • Progressive exercises to improve flexibility (especially of the calf muscles)
  • Activity modification advice
  • Footwear advice
Shin Splints

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Amy's been extremely helpful, informative and lovely to talk to during my foot appointment the last few visits. 100% recommend their services.
Darryl Rebbetts
Darryl Rebbetts
26/10/2022
Have had scan and chiropodist treatments and both were carried out with care and I was informed what would be done. I would highly recommend the Sussex foot centre for treatments.
Sheila Stobbs
Sheila Stobbs
15/10/2022
I was misdiagnosed by my GP after injuring myself long distance walking. Now I not only know what's wrong with me, but also how to remedy it so I can walk again. Great attention to detail. Thank you 😊
Liz Platt
Liz Platt
09/10/2022
Fantastic experience with the whole practice, there’s no where I’d trust more. Originally I went to have one issue sorted out, and have found another to be dealt with alongside. A practice where you feel listened to and taken seriously. Thanks again!
Nikki Martin
Nikki Martin
07/10/2022
Had an appointment with Jon Collins about a sore heel. Had a scan on both heels, which was followed by a detailed analysis of the results and an explanation (in layman's terms) what the issue was. Very impressed with his knowledge, how it was imparted and happy with our agreed action plan.
Jonathan Whitnall
Jonathan Whitnall
25/09/2022
Over the last 4 years or so, I have visited a number of professionals including physiotherapists, chiropractors and osteopaths. I was experiencing recurring injuries in my left knee and hip from sports and from attempting to walk mid-distances. The pain was starting to flare in my back too. I was following the physiotherapists’ advice religiously and attending appointments regularly. However, the programme of exercises tended to make the pain worse rather than better. To add to my frustration, I was also misdiagnosed with a hip condition. In the back of my mind, I always felt there was something biomechanically incorrect in the way I move but I was reassured that was not the case until…..I booked an appointment with Jon at Sussex Foot Centre for a gait assessment. Jon quickly recognised the issue with my feet and their incorrect positioning. I was prescribed custom orthotics and after a few months of perfecting these, Jon then created my semi-permanent pair of orthotics. I have been walking further than I have done and am now back on the courts playing tennis, which I love, and never thought I would be able to do again. The whole team at Sussex Foot Centre are very helpful and efficient. My treatment is ongoing so as long as Jon is a podiatrist, I am his patient :) Thank you for everything!
Katherine Morley
Katherine Morley
22/09/2022
I had nail surgery last October and after all this time I can say it was worth it. Jon didn’t rush me into it and gave me all options available, in the end I decided to go for the surgery and Jon made it so easy and everything was explained to me before, during and afterwards. Any questions I had were always answered by Jon or one of his team and put my mind at rest (I’m a bit of a worrier). Can’t thank them enough for helping with something that I had tried to ignore for years.
Gavin Robertson
Gavin Robertson
01/09/2022
I highly recommend Sussex foot centre. I booked an appointment for the shoe insoles and Jon was very helpful and professional. He provided a great solution for me and I feel much better since I wear my new insoles. The entire team is also very nice and helpful with booking the appointments around my work schedule.
Michał Piotrowski
Michał Piotrowski
22/07/2022
After the NHS screwed up my ingrown toenail operation twice this year I decided to go private and it was the best decision. I was seen really quickly and toes healed within a couple of weeks, highly recommend sussex foot centre.
Lauryn Spink
Lauryn Spink
22/07/2022