8/19/2018

Shin Splints

Shin Splints

Shin splints are a common problem which cause pain in the lower leg. Shin splints can be broken into two basic categories;

Anterior Shin Splints -

Anterior shin splints are considered an excessive use syndrome of the tibialis anterior muscle and tendon. The symptoms of anterior shin splints take place at the origin of the tibialis anterior muscle and tendon (the origin of a muscle and tendon is where it begins and is anchored to the bone). In the case of anterior shin splints, the origins may be the tibia, or shin bone. Anterior shin splints are the most common form of shin splints.

Tendon affected tibialis anterior Tendon perform deceleration of the foot in swing period and heel contact Location of pain front of the shin and ankle

  • Diagnosis of anterior shin splints is usually based upon the location and character of the symptoms.
  • Diagnostic testing may include x-rays, bone reads or MRI studies to rule out tibial stress fractures.

We all recognize the fact that anterior shin splints are a mechanical problem, we are safe to assume that a mechanical solution is in order. The main element to treating anterior shin splints is to change the functional length of the actual tibialis anterior muscle and tendon (biomechanical changes). The symptoms of irritation may be taken care of concurrently, yet without treating the physical element of anterior shin splints, recurrence is likely.

Decrease the length of stride. Taking shorter steps decreases the functional period of the particular tibialis anterior and subsequently reduces the pull of the muscle on the tibia.

  • Modified arch support to decrease the functional length of the particular tibialis anterior.
  • This can be accomplished by increasing the arch of an arch support or orthotic distally to reach under the first metatarsal and also big foot joint.
  • Changes should be made slowly and incrementally.
  • As you build up as well as extend the arch, you are decreasing the functional length of the tibialis anterior.
  • Addition to be able to treating the mechanics of anterior shin splints, extra care can be used to calm the inflammation related to this condition.
  • This gets increasingly important as the severity of the condition increases.
  • Ice before and after activity helps.
  • Anti-inflammatories or ultrasound treatments also help.
  • As a last resort, rest is helpful but by no means a final solution.
  • Rest can be as simple as a decrease in activity, a walking cast or even a cast with crutches.
  • It is important to recognize that rest without treatment of the biomechanical origin of this problem will never be a final solution.

Posterior Shin Splints -

Posterior shin splints are seen less often than anterior shin splints, but are none the a smaller amount, just as unpleasant. The start of pain as well as the location vary just a bit;

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Tendon impacted tibialis posterior Tendon function assistance of the medial midfoot ( arch ) and plantarflexion of the base at toe offLocation of pain guiding the medial malleolus (inside ankle bone)

The posterior tibial muscle originates from the back of the tibia, deep to the calf muscle. As it descends the leg it narrows to be able to become the rear tibial tendon. As the posterior tibial muscle descends the particular leg, the result is a way instantly guiding the particular posterior aspect of the medial malleolus (ankle bone)making an sudden turn to continue to the medial arch. In the arch of the foot, the posterior tibial tendon branches into nine different insertions in the bottom of the foot. Rear shin splints are usually a true type of tendonitis and happen in the body of the tibialis rear tendon at the rear of the medial malleolus inside ankle bone).

To effectively deal with any form of tendonitis, we must realize that tendonitis is an over-use condition. Therefore, effective treatment lies either in modifying the way the tendon functions alignment changes) or changing the activity that plays a role in overuse. We know that the function of the tibialis poster tendon is to support the arch. Eventually we can support the function of the tibialis posterior tendon by supporting the arch with a rigid arch support. The tibialis posterior can also be assisted by increasing the heel with a firm heel lift and by performing calf stretches to weaken the calf muscle. The calf muscle has a significant influence on the function of the posterior tibial muscle. For more information see the 'additional information' tab on this page.

Part of treating shin splints is treating the inflammation found in both anterior and posterior shin splints. Treatment of inflammation is essentially the same in either posterior or anterior tibial tendonitis and also includes ice, medications, ultrasound or rest.

Nomenclature:

Functional amount of a muscle - each and every muscle and its' associated tendon have a normal range of excursion of length in which they are accustomed to working. This normal length is referred to as the functional length. That length of function.

Shin - refers to the lower leg, much more specifically, the tibia or larger bone of the leg.

Anatomy:

Anterior shin splints -

Knowing the origin of the tibialis anterior muscle becomes important when trying to differentiate the numerous cause of shin pain. First, let us take a look at some simple anatomy. As we mentioned, the tibialis anterior muscle and tendon originate from the front of the tibia or shin bone. This origin begins just distal to the knee and continues halfway down the leg, as a result we can say that the origin of the tibialis anterior muscle could be the proximal half of the tibia. Also, the origin is not just on the front of the tibia, but actually tucked a little under the lateral or outside edge of the tibia.

Posterior Shin Splints -

The posterior tibial muscle originates from the rear of the tibia, deep to the calf muscle. As it descends the leg it narrows to become the posterior tibial tendon. As the posterior tibial tendon descends the leg, it follows a path immediately behind the particular posterior aspect of the medial malleolus (ankle bone)making an abrupt turn to continue to the particular medial arch. In the arch of the foot, the posterior tibial tendon branches into nine different insertions in the bottom of the foot. Posterior shin splints are usually a true form of tendonitis and occur in the body of the tibialis posterior tendon behind the medial malleolus within ankle bone).

Biomechanics:

Anterior shin splints -

Now Let's Chat Biomechanics

As we walk or run, the tibialis anterior offers two functions. The very first takes place at heel make contact with when the tibialis anterior works to slow the motion of the feet as it hits the ground. Without a tibialis anterior muscle tissue as well as tendon, the foot would slap the floor. This slowing action is referred to as deceleration and contributes to the controlled steady motion of the ankle to which we are so accustomed. The second function of the tibialis anterior is to lift the foot during the swing phase of gait. Swing phase is the time when there is no weight on the foot following toe away and just prior to heel get in touch with. During swing phase, the tibialis anterior lifts the foot to prevent it from dragging on the ground.

Quite often the cause of anterior shin splints ends striding. Above striding increases the normal functional length of the tibialis anterior. Essentially, much of the range of motion of your muscle and tendon has to do with the changes in its' overall length. In the case of the tibialis anterior, we all know that at heel contact, the muscle acts in order to decelerate the actual foot as it hits the ground. As the foot moves to hit the ground, the tibialis muscle tissue and also muscle lengthen. So, if we increase the length of stride, the tibialis anterior muscle and tendon lengthen a lot more. In the case of anterior shin splints, the tibialis anterior muscle and tendon can not keep up with the demands placed upon it and, as a result, actually starts to find new ways to gain timespan. Quite often that additional length is gained by the muscle pulling away from it's origin. In the case of the tibialis anterior muscle and tendon, we call that anterior shin splints.
  • We know that anterior shin splints are common in runners, but let's utilize a good example found in everyday life.
  • Bridgit is a fresh postal worker.
  • She's 5'2" tall and she has training for a walking mail path in her home town.
  • Her mentor is Jim who has worked the route for decades.
  • Jim is 6'3" tall.
  • Jim as well as Bridgit begin to work together walking the eight mile route everyday.
  • Bridgit desires to get this new job, so she tries her hardest to keep up with Jim despite the fact that she has a hard time.
  • Jim is so much bigger, as well as to simply keep up, Bridgit has to over stride in order to compensate for their physical differences.
  • By the end of the first week, Bridgit's in trouble.
  • She's pain in the front of her shins.
  • She has anterior shin splints.

Posterior Shin Splints -

The tibialis posterior muscle and tendon acts as the primary support of the medial arch. The tibialis posterior muscle and tendon also works to be able to plantarflex the feet at toe off and allows the Achilles tendon in its' function to move us all forward.

When we consider dealing with the symptoms of posterior shin splints, we need to consider the function of the posterior tibial tendon (PT tendon). Many cases of posterior shin splints are caused by increased activities with no control of pronation. The full alignment definition of pronation is somewhat intricate, but for our discussion, consider pronation to be able to mean flattening of the arch. The mid stance and bottom off phases of gait place a significant load on the posterior tibial tendon. The PT muscle will attempt to maintain the normal elevation of the arch and aid in toe off, assisting the calf and Achilles muscle. If the loads applied to the actual PT improve faster than what the tendon can accomadate, tendonitis will result.

  • The PT tendon is easily supported with a rigid arch support throughout mid stance phase of gait.
  • Load to the tendon can be reduced at toe off by extending the calf muscle on a regular basis.

Symptoms:

Anterior shin splints -

Earlier in this discussion we reviewed some anatomy and defined the origin of the tibialis anterior muscle and muscle on the anterior and antero-lateral aspect of the tibia. Anterior shin splint pain is very specific to this area.

  • The early stages of anterior shin splints, pain is very similar to that of other forms of tendonitis.
  • Sharp pain on the anterior lateral tibia will be significant upon the onset of an activity.
  • As the activity moves along, the pain goes away until the conventional end of the activity is reached, at which time the same pain returns.
  • Advance cases of shin splints, in addition to the pain with the activity, the origin of the tibialis anterior becomes inflamed and cannot heal.
  • This results in chronic pain from inflammation at the origin of the tibialis anterior.

Posterior Shin Splints -

The signs and symptoms of posterior shin splints are uniquely more advanced than anterior shin splints. Rear shin splints are usually the result of inflammatory pain of the posterior tibial tendon. The symptoms of posterior tibial shin splints occur 8-10m cm proximal to the most distal tip of the medial malleolus (inside ankle bone). Inflammation may occur but is going to be minor.

Posterior shin splints exhibit classic tendonitis symptoms. In the early stages of posterior shin splints, pain is noted at the beginning of your activity and seems to 'warm up' over the first five minutes or so of the exercise. In advanced cases, pain is constant and can be aggravated by any form of weight bearing.

Differential Diagnosis:

Stress fractures with the tibia present with pain similar to anterior shin splints.

Posterior Shin Splints -

Conditions that may resemble posterior shin splints include tarsal tunnel syndrome, tibial stress fractures, posterior tibial muscle rupture, flexor hallucis longus tendonitis, gout, arthritis of the subtalar joint or a fracture of the posterior process of the actual talus.

About the author:Jeffrey A. Oster, DPM, C.Ped is a panel certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Medical professional. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.