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Shin Splints / Medial Tibial Stress Syndrome

- Discussion:
    - a complex syndrome characterized by exercise induced pain in mid leg;
    - contributing factors include varus hindfoot, excessive forefoot pronation, genu valgum, excessive femoral anteversion, & external tibial torsion;
    - may encompasses a wide spectrum of disorders including periostitis near origin of soleus & FDL muscle origins and stress fractures;
           - probably not relate to pathology of the origin of the tibialis posterior;
    - involved in the etiology of shin splints is the normal pronation of the forefoot during stance phase;
           - stance phase pronation allows for shock absorption;
           - excessive or unbalanced pronation may be a cause of shin splints;
    - shin splints are rare w/ age < 15 years;
    - differential diagnosis:
           - stress fracture
           - chronic compartment syndrome
           - sciatica
           - DVT
           - popliteal artery entrapment
           - muscle strain
           - tumor
           - infection

- Exam:
    - tenderness is localized to posteromedial border of tibia in mid to distal third regions;
    - tenderness is usually more localized with stress fractures;

- Radiographs: usually normal in periostitis

- Bone Scan:
    - periostitis appears as linear streaking over posteromedial aspect of the tibia;
    - stress fractures differ in that uptake is localized;

- Treatment:
    - rest is the key to treatment of stress fractures and periostitis'
    - stress fractures may take up to 12 weeks to heal completely;
    - casting may be indicated;
    - fasciotomy of the posterior superior compartment may be indicated in severe cases

The medial tibial stress syndrome. A cause of shin splints.

Medial Tibial Stress Syndrome. The Location of Muscles in the Leg in Relation to Symptoms.

The Incidence and Risk Factors in the Development of Medial Tibial Stress Syndrome Among Naval Recruits.

Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome