Case Study December 2016 – Shin Splints
Shin Splints is a common condition affecting runners and recreational athletes of all levels. It is a generic term referring to pain in the lower leg, usually around the medial / posterior margins of the tibia or the anterior muscle group of the shin.
A 32 – year old female of Caucasian decent presents to the clinic complaining of pain in the lower limb of approximately 5 months. She informs the Sports Podiatrist that she runs 5 mornings every week, covering 5-7 km’s each run and has felt a gradual increase in symptoms over this 20 week period. She is training for a half marathon and covers a kilometre in approximately 4 minutes. She has never had Shin Splints before but has suffered with a lateral calf strain in her right leg. Over the last 3 weeks, she reports that these Shin Splints type symptoms have been apparent throughout day, with regular walking such as to and from her office. She informs the Sports Podiatrist that the only thing that is different about her training is a change in the model of her running shoes. She has always ran in the Asics Gel Kayano, but decided to try a lighter, more minimal shoe and so she changed to an Asics DS Racer. Within a few weeks of using the new Asics, her Shin Splints started to develop and within the first KM of running her legs would hurt.
This patient informs the Sports Podiatrist that she is otherwise fit and healthy, takes no medications and aside from the calf strain has had no other foot or leg injuries to speak of. At the time of her first appointment with the Podiatrist she had not ran for 10 days, but her Shin Splints were still apparent.
She had tried to treat her leg pain by applying ice packs to the lower leg area and would rub her thumbs upwards, along the medial side of the tibia, in the area where she felt most of the pain. She had Googled Shin Splints treatment which led her to seek the help of a Sports Podiatrist.
Shin Splints Assessment
The Sports Podiatrist carried out a thorough physical examination which involved firm palpation of the muscles and tendons of the lower leg and foot. With the patient lying supine, she reported pain when pressure was applied to the Tibialis Posterior muscle origin, along the medial side of the tibia. This is a typical finding in patient’s with Shin Splints. The Podiatrist then applied pressure to the Tibialis Posterior tendon, more distally, as it descends around the medial malleolus (ankle bone) and into the navicular (mid foot / arch area). This also elicited pain on palpation which confirms the condition we refer to generally, as Shin Splints.
Running Shoes and Shin Splints
The patient was then asked to put her running shoes on so that we could observe her running on a treadmill. Bisection lines were drawn on the Achilles Tendon and the posterior aspect of the lower leg. The patient ran on the treadmill at 16ks per hour while the Sports Podiatrist recorded her using digital software. She reported that she could immediately feel pain from the Shin Splints while running at this pace.
The captured video was replayed in slow motion by the Sports Podiatrist so that the running shoes could be assessed. The patient was also able to observe the replay. It became apparent very quickly that the Asics DS racer was collapsing under load, with every foot strike. The medial side of the running shoe compressed dramatically, which allowed the foot to over pronate. Over pronation can lead to Shin Splints as it allows excessive strain through the Tibialis Posterior muscles and tendons. It seemed that this change in running shoes was the likely cause of this patient’s Shin Splints.
The patient was also asked to run bare foot so that her natural foot function could be observed. Again, over pronation was evident during walking and running. A common cause of over pronation is ligamentous laxity, and hence Beighton’s test was carried out. This test looks at ligaments throughout the whole and body and the patient scored 8 out of 9. It was concluded that the cause of over pronation was a genetic trait, and that the patient’s foot ligaments did not provide sufficient control and support. This lack of support from the ligaments and running shoes led to her Shin Splints developing while running.
This patient also had tightness in her lateral calf which is common in people who over pronate. In a standing position the patient’s medial arch heights measured 18mm left and 20mm right – which can be classed as low arches / flat feet. Again, this arch drop comes from a lack of ligament strength.
Shin Splints Treatment
The Sports Podiatrist advised the patient that she must stop using the Asics DS Trainer running shoes, and revert back to a stronger shoe. She was given a specific model to use for her foot type. She was also advised that in order to control her over pronation, and to treat her flat feet / Shin Splints, it would be important to use prescription orthotics. Using a digital 3D foot scanner, the patient’s feet were scanned and measured for Carbon Fibre, lightweight orthotics. These would have soft EVA top covers and slow release poron for cushioning. The orthotics would be designed with rear foot control to correct the over pronation while offering gentle arch support. This would allow the Shin Splints to settle by unloading the Tibialis Posterior muscles and tendons.
The Sports Podiatrist also advised calf stretching with the foot supinated, to release the lateral calf. Ice packs were to be continued daily until the Shin Splints had settled completely. This was expected to take 4 to 6 weeks. The patient was asked to refrain from running for 4 weeks from date of initial appointment. This would allow 2 weeks of rest and 2 weeks of walking with the orthotics and the new running shoes before attempting a short 3k run.
6 Week Review of Shin Splints
The patient was comfortable in her Brooks Glycerine and new Carbon Fibre orthotics. She informed the Sports Podiatrist that she had walked in her orthotics for 2 weeks and had attempted a short run not long after. There was mild pain while running and so she restricted herself to walking only. The day to day pain from the Shin Splints had subsided. She then ran at 5 weeks , after walking in the orthotics for weeks, for 3k’s and reported no pain during the run, only slight stiffness the morning after. Her calf range had improved due to regular stretching. This patient was advised to gradually increase her running programme and to continue all treatment’s. The Sports Podiatrist insisted she return to the Martin Place clinic if her symptoms retuned. An annual orthotic check up was also advised.
Please note: The circumstances outlined here in this case study should not be taken as general advice. If you suffer with Shin Splints or any other form of running injury you should seek the help of a Sports Podiatrist.