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A Primer on Lower-Leg Pain
Shin splints, stress fracture, compartment syndrome, tendonitis and more
By Cathy Fieseler
As featured in the April 2010 issue of Running Times Magazine
print mail
view page: Prev 1 2 3 Next
The shin or lower leg includes everything between the knee and ankle, and is a prime spot for
pain in runners. Let's look at the anatomy of the area and some of the most common problems
runners get in and around their shins.
The tibia is the large bone of the lower leg; the fibula is the thin bone
along the outer aspect of the lower leg. There are four compartments
in the lower leg, each of which includes several muscles along with a
nerve, artery and vein. Each compartment is surrounded by a tissue
known as fascia. The muscles in these compartments control motion
of the foot and ankle. Many of the thigh muscles attach to the top of
the tibia and fibula. Differentiating between specific causes of lower
leg pain may be difficult due to overlapping symptoms.
SHIN SPLINTS
This term is used to describe pain along the inner tibia. Typically the
pain involves a third or more of the bone. The pain develops while
running and resolves afterwards; it usually improves with continued
training. The inner aspect of the tibia will be tender to touch, with no
area more tender than another. There may be mild swelling in the
lower leg.
The pain is due to microscopic tears of the muscle away from the lining of the bone. Predisposing
factors include overpronation and running on hard surfaces. Shin splints are more common in novice
runners. Treatment of the problem includes icing after exercise, appropriate footwear or possibly arch
supports, and changing running surface. Improving flexibility of your calf muscles and the strength of
the muscles in the front and sides of your lower leg are important in treating and preventing this
problem. To strengthen the muscles of the lower leg, place a weighted ring on your foot. Point your
foot up, in and out 10 times; perform three sets. The pain usually subsides as fitness improves.
STRESS FRACTURE
Also a source of bony pain, a stress fracture is an injury to bone due to repetitive microtrauma. Bone
responds to stress by becoming stronger; the stress causes bone resorption, which is followed by
bone building, as long as the stress isn't overwhelming. With excessive stress, resorption is greater
than the building phase, leading to microscopic trauma and microfractures. Repetitive microfractures
result in a stress fracture.
The typical presentation is bony pain with impact. Initially the pain develops during the run, but may
even resolve during the course of the run. Over time, the pain is present throughout the run and may
be present while walking. Mild swelling may be present in the lower leg. Continued impact on a stress
fracture can result in a complete fracture through the bone.
On clinical examination there is a specific area of significant bony tenderness. There is pain or even
inability to hop on the single leg. X-rays will not reveal abnormalities for at least two weeks and
possibly much longer. MRI and three-phase bone scans can detect stress fractures much earlier.
Stress fractures in runners tend to occur in the lower aspect of the fibula and in the upper and lower
aspects of the tibia. They can also (though less commonly) occur in the front of the tibia; this stress
fracture can be problematic in healing due to the shape of the tibia.
view page: Prev 1 2 3 Next
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