If you are a runner, you have likely experienced at some point that pulling pain along your lower legs. Most people report symptoms as a dull ache along the front part of the lower leg, pain along the inner part of the lower leg, pain on either side of the shin bone, muscle pain, or swelling of the lower leg.
In some rarer cases, people will also experience numbness and weakness of the feet. This is generally known as “shin splints”, or medial tibial stress syndrome (MTSS). Typically it coincides with exercise and may be associated with changes to training level, intensity, duration, running surface, or footwear. It is a common condition said to affect anywhere between four to thirty five percent of athletes.
Medial Tibial Stress Syndrome
MTSS is an overuse injury that is most commonly caused by excessive pronation and repetitive impact activities. Pronation, or the way that the foot rolls inward upon impact with the ground, is the body’s natural mechanism for shock absorption. During this process, the lower leg, knee, and thigh also rotate internally.
In cases of excessive pronation however, the arch of the foot flattens and inward rotation of the foot is exaggerated. This increases stress on the muscles, tendons, and ligaments of the foot and lower leg, causing lower leg pain. With repetitive high impact activities such as running, the frequent strain will often cause inflammation and swelling about the lower leg, exacerbating the pain.
In most cases, MTSS is easily managed with rest, ice, and the use of nonsteroidal anti-inflammatory medications. Sports massage and calf stretching exercises may also be used to reduce tension in the muscles of the lower leg. Once the acute symptoms have resolved, it is important to identify and correct the triggers of MTSS.
Physical therapy is a wonderful option for those seeking professional assistance with learning proper stretching techniques, creating a proper training program focused on gradual conditioning, and addressing biomechanical issues. There are also many orthotists in the area who can create customized shoe inserts that help correct any alignment issues, such as over-pronation of the feet. It is generally treated non-surgically with great success.
While MTSS is a relatively benign condition, lower leg pain, swelling, numbness, and weakness can also indicate more serious conditions such as: stress fracture, exertional compartment syndrome, popliteal artery entrapment syndrome, various nerve entrapment syndromes, or gastrocnemius-soleus muscle strain. These can often be confused with MTSS given the similarities in their symptoms and cannot be identified without advanced imaging studies such as x-ray, CT, MRI, MRA, or Doppler ultrasound.
If you a runner with leg pain and have not responded to standard therapies, it is important to seek out a qualified foot and ankle orthopedic surgeon.