Leg Pain-It's Not Always Shin Splints

By Robert H. Sheinberg, DPM, DABPS, FACFAS

Pain in the lower leg must be evaluated thoroughly in order to determine the exact problem.  There are four conditions that can lead to leg pain.

I. Stress fractures.

Stress fractures are micro fractures that can occur in any bone of the lower extremity or spine.  The most common presentation is a patient who presents with a sudden alteration in their training program (i.e. more sprinting, increased mileage or increased training intensity) who have developed pinpoint pain and localized swelling over the involved bone.  Pain is often mild in the early part of activity but over the course of the day or your activity the pain gets worse to a point where the athlete or person cannot tolerate weightbearing.  The best treatment for this condition is to limit the activity that is precipitating the problem.  Temporarily immobilizing the foot, ankle or leg in a boot or brace may be necessary to allow the area to heal.  Cross training is allowed during the healing process. 

II. Tendinitis.

Tendons connect muscles to bone and are responsible for movement of the joints.  When the covering of the tendon is inflamed it is referred to as tendinitis.  When the injury becomes more chronic and it affects the main body of the tendon, it is called tendinosis.  It is common in athletes or workers in high repetition activities.  It is also seen in people who are unaccustomed to an activity.  It frequently occurs in people who do not stretch frequently.  A sudden alteration in a training program may also precipitate this problem.  Stiffness is often present at the early part of an activity.  The tendon and inflamed area usually loosens with weightbearing; however, by the end of the activity the pain increases.  The best treatment is to cease the activity that is causing the problem.  Physical therapy, medication and occasionally immobilization may be necessary during the healing process.  If treated early the long-term prognosis is excellent.

III. Chronic Compartment Syndrome.

The muscles in the lower leg are grouped into four compartments.  During exercise these muscles in the lower leg may engorge with blood, causing them to enlarge.  If the compartment that they are in is not able to expand, pain, weakness and numbness and tingling may develop in the front or outer part of the leg.  Symptoms usually develop at a specific time during the activity.  It is difficult to almost impossible for an athlete to run through this type of problem.  The leg may feel tense when touched.  This condition usually does not subside with time.  Treatment may be aimed at changing the activity.  Physical therapy to increase flexibility and improve muscle strength may provide benefits.  For a faulty mechanical problem orthotics for the shoes may also help.  In many cases surgery is necessary to eliminate the problem and completely restore the athlete back to full activity including running long distances. 

IV. Shin Splints.

Shin splints occur when the muscles in the lower leg pull on the bone, causing the muscle-bone junction to become inflamed.  It may be seen in unconditioned athletes in the beginning of a training program.  It is made worse by tight calf muscles and weak muscles on the inside of the leg.  Flat feet or very high arched feet may aggravate the condition.  Pain is usually diffuse along the shinbone.  Swelling is usually not seen.  It is important to identify the cause of this problem.  Physical therapy may help to stretch tight muscles and strengthen weak ones.  Rest during the acute phase may also be beneficial.  Shin splints sleeves and orthotics may also provide benefits, especially if the person is flatfooted or has a high arch.  Immobilization may be necessary in a boot to allow complete healing.

Early identification and proper treatment will enable all athletes and patients to return to their desired activity with an excellent long-term outcome.