Shin splints is a general catch all term used to describe pain in the front of the lower leg of where there are a number of specific causes.
It is not specifically a diagnosis in itself but is well known among athletes to describe shin pain.
One of the most common causes is medial tibial periostitis which we have described on our shin splints page and is an inflammation of the sheath surrounding the bone on the inside of the lower leg.
Most causes of shin pain in athletes will be related to one or more of the following issues:
- Bone stress which can range from a mild bone strain to a full stress fracture.
- Insufficient blood flow through arteries and veins either through poor circulation, thrombosis or disease blocking blood flow, or increased pressure from muscles surrounding the blood vessels.
- Inflammation of the tendons which insert at the lower third 108711597 of the inside of the shin.
- A compartment syndrome where the pressure inside a muscle compartment is increased causing pain.
- Nerve entrapment such as the peroneal nerve becoming impinged.
Below we explain the more common injuries causing shin pain as well as less common and important conditions that should not be missed. We also mention some of the very rare causes of shin pain which a doctor or sports medicine practitioner should be aware of.
Less common causes of shin pain
DVT or Deep Vein Thrombosis is a blot clot in a vein commonly seen in the calf muscle particularly following surgery and long-haul flights. Symptoms include constant pain and tenderness at a point deep in the muscle. It essential this is correctly diagnosed as should the blood clot come loose for example with massage then it could find its way into the heart and cause death.
Stress fracture of the fibula is a hairline fracture of the the fibula bone which is the smaller non weight bearing of the two shin bones. Pain is not usually as severe as a stress fracture of the tibia and pain may also be felt as calf pain.
Popliteal artery entrapment also is more likely to appear as calf pain rather than shin pain but pain can be felt on the outside of the shin in the anterior compartment or big muscle on the outside of the shin.
Referred pain where a problem or injury elsewhere causes pain in the shin is not common but can occur from the spine, from the ankle joint or from a cyst on the knee cartilage or from a Baker's cyst or ganglion cyst - a bakers cyst is a swelling behind the knee although this can cause pain down into the shin it is not particularly common.
Osgood schlatters disease is a painful injury of the knee affecting children between the ages of 8 and 15 years old. Pain is felt on the bumpy bit at the top of the shin but may radiate down.
Pes anserine bursitis is inflammation of a bursa or sack of fluid on the inside of the knee. Pain is more usually felt on the inside of the knee rather than the shin.
Other less common causes of shin pain in the athlete include Femoral endarteritis, Athlerosclerothic disease, Proximal tibiofibular subluxation and Dehydration resulting in cramp.
Important not to be missed causes of shin pain
Tumurs of bone and soft tissue are rare but most likely occur in athletes in their 20's and 30's. Osteosarcomata can occur in the ends of the long bones particularly of the lower leg causing joint pain.
Infection such as osteomyelitis or cellulitis. There are three main types of osteomyelitis. The condition can be classed as acute, sub-acute or chronic depending on the time frame between the initial infection or injury and the bone infection developing. This can be two months or more in chronic cases.
Acute compartment syndrome is where there is bleeding or swelling within the muscle usually from a direct blow or contusion which increases the pressure within the muscle sheath causing pain.
Very rare causes of shin pain
The following conditions are very rarely seen as a cause of shin pain, however a doctor or professional practitioner should be aware of them, particularly if shin pain is persistent or not responding to conventional treatments. These include syphilis, sickle-cell anemia, hyperparathyroidism, sacrcoidosis, rickets, pagets disease of the bone and erythema nodosum.