II. Pathophysiology

  1. Injury to Tibialis Posterior and Soleus Muscles

III. Risk Factors

  1. Poor flexibility
  2. Over-pronation or increased internal tibial rotation
  3. Worn or improper shoes
  4. Running on Hard surfaces
  5. Early season hill training
  6. Increased training intensity, pace or distance
  7. Miserable Malalignment Syndrome

IV. Symptoms and Signs

  1. Localized pain at distal third of medial tibia
  2. Pes Planus associated with over pronation

VI. Management

  1. Alphabet writing range of motion Exercises with foot
  2. Ice massage
  3. Transverse friction massage (TFM)
  4. Cushioned anti-pronation inserts (CAPI)
  5. Local Ultrasound with Phonophoresis
  6. Sleeve, strapping, brace
  7. Decrease training and avoid hills
  8. Consider cross training activities
  9. NSAIDs
  10. Limit activity to soft surfaces

VII. Management: Algorithm based on severity

  1. Mild Shin Splints
    1. Implement above measures
  2. Moderate Shin Splints
    1. Implement above measures
    2. Replace Running with non-provocative activity
    3. Consider evaluation for Tibial Stress Fracture
  3. Severe Shin Splints
    1. Implement above measures
    2. Long air cast
    3. Evaluate for Tibial Stress Fracture
    4. No weight bearing sports until
      1. Two weeks of rest and
      2. Negative Hop Test

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