By Peter Foley (Registered Podiatrist)
What are Shin Splints?
Shin splints, stress fractures of the tibia or Medial tibial stress syndrome (MTSS)* is one of the more commonly reported injuries in footballers, especially in those who cross train with running. MTTS describes a condition of pain at the join between muscle and bone at the inside (medial) edge of the shin bone (tibia). In some situations MTTS can progress to tibial stress fractures.
Symptoms of MTSS
Typically a patient with MTSS will be exquisitely tender to push on the inside edge of the bone 10-20cm above the inside of the ankle joint. Often the patient will report pain in this area at the start of a training session or game. Initially the pain will diminish as the patient warms up. As the injury deteriorates the athlete will report pain with less stimulus and the pain will persist through the session and continue for some time after finishing the game.
Causes and risk factors associated with the development of MTSS
The most common muscle involved is the soleus muscle (the deeper, flatter muscle in the calf compartment) and the condition is caused by persistent inflammation at the periosteum (the skin of the bone). Individuals with tightness in this muscle are at higher risk than other patients. Another well documented risk factor for MTSS is excessive flattening of the arch on weight bearing (flat feet) as it is thought the leg muscles have to work much harder to stabilise the more flexible foot.
Other risk factors include patients with leg length differences, athletes who alter their training load quickly and patients with poor postural control. Importantly, the risk for female athletes can be up to 3 times higher than their male counterparts.
Footwear/Athletic shoes may play a role in the development of MTSS. Typically soccer boots will have less heel pitch than a running shoe which increases the traction through the calf muscles. Many boots do not feature the same medial supports that running shoes do which can again increase the load on the relevant muscles.
There can be other causes of shin pain that can appear similar to MTSS, including compartment syndrome, peripheral vascular changes in older patients and tibia stress fractures. It is particularly important that tibia stress fractures are correctly diagnosed and treated as soon as possible to prevent worsening of the condition.
Treatment for MTSS will depend partly on the severity of the condition. Treatment may consist of activity modification, restructuring training, stretching and strengthening work and footwear recommendations. In patients with flat feet, orthotics may be an effective treatment for patients with MTSS . While fitting orthotics in football boots can be a little tricky it is possible with the right know-how.
At Spine Sport Feet clinic our team of podiatrists can help to assess your injury, confirm its diagnosis and get you a management plan to reduce time spent on the sidelines. If orthotics are required we can ensure that it fits well in your boots and your day to day footwear.
* Also referred to as medial tibial traction periostitis.
1: Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train. 2016;51(12):1049-1052. doi:10.4085/1062-6050-51.12.13