Shin splints (anterior/posterior tibial tendoniitis)


Shin splints (tendoniitis)

Shin splints is an over use injury which relates to muscles in your legs working harder than they are able to do. This results in them becoming strained, inflamed and in more chronic situations can lead to stress fractures in you tibia (lower leg bone) if untreated.

There are 2 main areas where people experience shin splints. Both of which can be extremely painful during and after running and can feel like the tibia itself is sore due to the pulling from the muscles which originate in this area. Or alternatively, the muscle belly on the outside of the lower leg (see picture)

The 2 main types are Anterior shins splints and possibly more commonly posterior shin splints (sometimes called medial tibial stress syndrome)

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There are a number of reasons for shin splints occuring:-

  • If you run on hard surfaces or slopes too much
  • Bulding up mileage too quickly when training for an event
  • Wearing poorly fitting or worn-out trainers that don't cushion and support your feet properly
  • Bioemchanical issues such as feet that either roll in too much (over pronate) or feet that don't roll in at all on walking (under pronate)
  • If your feet roll inwards excesively , as this puts more pressure on your lower legs
  • If you have weak ankles or a tight Achilles tendon (the band of tissue connecting the heel bone to the calf muscle)
  • If you have tight calf muscles

Anterior shin splints:- Anterior shin splints typically present as pain at the top of the shin bone towards the outside area of the leg (below the knee). The anterior tibial muscle normally pulls your foot up (dorsiflex) and inwards (inversion). If this over works due to the volume of walking or running you do, or if your foot biomechanics isn't quite, the you are prone to shin splints in this area.

Posterior shin splints (Medial tibial stress syndrome):- Posterior shin splints are probably more common. There is a specific pain immediatley behind the shin bone on the lower 1/3 of the leg (on the inside). This is very specificially the posterior tibial muscle and often experienced just before the leg pushes off on to the next step.

There can also be pain or discomfort radiating down to the inside (medial) aspect of the ankle to the top of the arch. This is where the posterior tibial tendon inserts into the inside area of the foot and arch area. This would be more inclined to be described as posterior tibial tendoniitis.

If you expereince pain in this area urgent assessment is required as prolonged issues in this area can lead to more serious problems.

Left untreated, posterior shin splints and posterior tibial tendoniitis can become more chronic and long term. Untreated this can progress to tiny stress fractures on the shin bone or the tendon can become stretched and elongated and work less effectively (posterior tibial dysfunction)


How to treat the symptoms of shin splints?

In the intial stages, shin splints should be treated by rest, ice, compression and elevation. If you are training for an event or increasing your activity, then reduce the activity to allow you to recover.

If the issue does not settle within a few days or continues to occur then you should consider using more supportive and cushioned footwear.

If you have done the above and you feel that the symptoms do not settle then you should seek the advice of an Orthotist or Podiatrist for a biomechnical assessment.

It is important to be sure that your walking or running style or foot mechanics are not contributing to your issues if the symptoms don't settle by rest and ice alone. There are a number of biomechanical issues that can contribute to shin splints.

  • Tight Achilles tendon
  • Leg length discrepencies
  • Previous injury
  • Joint alignment issues within the foot
  • muscle imbalance/weakness
  •  Running style
It is important that a biomechanical assessment is undertaken by a qualified Orthotist or Podiatrist to establish the reason for your issues, and how we can treat the problem. Our clinicians in our biomechanics clinic in Hamilton, South Lanarkshire (near Glasgow) can advise on how you can manage your shins splints (or tendoniitis).

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From this assessment Orthotics (special insoles), stretches and strengthening of muscles and tendons are often prescribed. 

In the treatment of shins splints orthotics are designed to influence the amount of "normal" pronation and supination in the foot to prevent the overuse issues. At the same time the orthotics need to ensure the correct amount of cushioning and control  to keep them both functional and comfortable.

Advice on footwear is required to use in conjunction with your orthotics. The right orthotics in the wrong running shoes can also be unhelpful. As such, our experience in running shoes will ensure your footwear is appropriate for your orthotics.

The other key consideration for orthotic treatment of shins splints and tendoniitis is that you need to use a clinician that will review your progress.

Often we find that we see patients who have had orthotics but have not been followed up properly to ensure as you build your mileage up that your orthotics are reviewed. Sometimes the control of your orthotic needs to be built up gradually, and this is done over a period of weeks.

Our full inclusive treatment which includes 3 months free unlimited follow up ensures we do this with you to maximise your outcome

To find out more about biomechanical assessments and orthotics provided within our orthotics and biomechanics clinic at The Treatment Hub in Hamilton (near Glasgow), South Lanarkshire, click on the links below.