Sports Medicine: Shin Splint

Part I: Knowing your feet

You know that annoying pain in your lower legs that never seems to get better? This leg pain always seems to slow your pace just when you are starting to make some real advance. This group of lower leg injuries commoly referred to as “shin splints”, is one of the most commonly occurring injuries in active people.

Unfortunately, the advice people get on the prevention and treatment of these injuries when shopping for athletic shoes is far from science.  Most people end up with shoes that are not helping their condition or are even causing it.

The good news is that with the proper shoe selection, shin splints can be prevented or reduced. The trick is to know the caracteristics of your feet, and to be able to match them with the key characteristics of an athletic shoe.

It all begins with knowing your feet. Many of us have heard before that we have flat feet, or an abnormally high arch. Knowing this information is crucial because the truth is, most of what we need in an athletic shoe revolves around our arch type.

Foot Types

A flat foot, commonly referred to as a pronated foot, is characterized by excessive motion. That means the foot is loose and “gives” too much under the weight of the body, thus appearing flat when bearing weight. A high arch foot, commonly called a supinated foot, has its own associated problems. A supinated foot is a rigid foot, and a poor shock absorber. As such, excess forces of movement get transferred up the leg to be absorbed by some other body part, in this case the bones of the lower leg.

A neutral (normal) foot is a middle ground between the pronated and supinated foot.  This foot type is the biomechanically correct foot and is not prone to either type of shin splint specifically, but symptoms may persist.  Chances are, if you have never heard one way or the other which foot type you have, you are neutral.

So, how do these foot types tend to cause shin splints? First we will investigate the pronating or flat foot. The tibialis posterior is the primary muscle responsible for maintaining the arch of the foot when you bear weight on the feet.

The pronating arch tends to collapse under load. A tug- of- war between the collapsing arch and the tibialis posterior occurs with each step. Over time the collapsing arch wins the war. Due to the excessive forces in the tibialis posterior, the muscle’s origin  begins to be pulled away from its attachment on the tibia.

Obviously very painful, a person experiencing this conditions will generally feel discomfort on the distal medial (lower inside) aspect of the leg felt near the border of the tibia and the soleus muscle, near the midpoint of the leg. Keep in mind that the pain may not be isolated to one spot because the origin of the tibialis posterior covers a large area.

Now we will turn our attention to the supinating (high arch) foot. Recall that this is a rigid foot and does not absorb shock well. As stated, this foot transfers more of the forces of impact up the leg. The tibia is the bone that suffers the most in this condition.  Hairlaine fractures may begin to from in the bone. A person with this type of shin splint will feel pain in the anterior distal (lower front) of the leg, somewhere on the bottom half the shin.

One can distinguish this condition from the flat foot shin splints because this type will be most teder to touch directly on the tibia (shin), usually anterior (in front of) the tibialis posterior muscle. This condition can further be identified by visible swelling (lumps) on the shins. In either type of shin splint, the pain will be the worse during and immediately after exercise.

Orthopedic Corner | Leon Mead MD Orthopedic Doctor | 730 Goodlette Road North, Suite 201  Naples Florida 34102 | Phone: (239) 262-1119