Pain in the shin is usually gradual onset and can be difficult to get rid of. Shin splints are known as pain on the inside of the shin but are not a diagnosis in itself but a description of symptoms. Most causes of shin pain in athletes are from bone stress, insufficient blood flow, tendon inflammation, compartment syndrome or nerve entrapment.
Shin splints is not a specific injury itself but are the common name often given to pain at the front of the lower leg of which there may be a number of causes. The most common cause is medial tibial stress syndrome.
Anterior compartment syndrome, also known as anterior shin splints arises when the big muscle on the outside front of the lower leg becomes too big for the sheath that surrounds it causing pain.
The tibia is the larger of the two shin bones and as a weight-bearing bone is more susceptible to stress fractures, particularly in the lower third. We explain the symptoms, causes, and treatment of a stress fracture in the tibia.
An acute fracture of the fibula bone in the lower leg occurs as a result of a direct trauma or impact to the leg or ankle. Stress fractures can also occur from overuse or repetitive impacts.
The tibia is the big bone in the lower leg. A tibial fracture is the most common injury of all long bone fractures and takes a variety of forms but usually involves a long period of immobility and a long recovery time.
Less common causes of shin pain
Although the various causes of shin pain known as 'shin splints' are relatively common there are other less common causes of shin pain which should be considered including important conditions which should not be missed.
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 nonweight 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 Schlatter's 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, Atherosclerotic disease, Proximal tibiofibular subluxation and Dehydration resulting in cramp.
Important not to be missed causes of shin pain
Tumors 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, sarcoidosis, rickets, Paget's disease of the bone and erythema nodosum.