Posterior Shin Splints
  • A complex syndrome characterized by exercise induced pain in the 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 and FDL origins and stress fractures.
  • Probably not related 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.
  • Excessive or unbalanced pronation may be a cause of shin splints.
  • Shin splints are rare with age under 15 years.

Differential diagnosis:

  • Stress fracture.
  • Chronic exertional 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.

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 may be indicated in severe cases.