Shin Splints - Treatment

Treatment

Correct diagnosis of the cause of pain or discomfort is necessary in order to choose the most appropriate treatment. Compartment syndrome may require immediate medical intervention, depending on the severity of the condition. Stress fractures require rest until the bone has healed. If needed apply ice to the injured area. The inflammation of soft tissue known as shin splints can be initially treated with rest, ice to reduce inflammation, NSAIDS, and physiotherapy. For healing, rest may be required for a couple of weeks or up to three months for severe cases. Crutches may be necessary for temporary non-weight bearing, casting of the limb is only recommended for severe cases. Patients may be advised to decrease the duration or intensity of their exercise and then build it up slowly, as well as to exercise caution on high impact surfaces, until the muscles re-condition. Specially fitted footwear or an orthotic may be used to prevent a reoccurrence of shin splints.

Acute phase of treatment options include resting and applying ice. Therapy option includes physical therapy modalities such as ultrasound, whirlpool baths, phonophoresis, augmented soft tissue mobilization, electrical stimulation, and unweighted ambulation. Subacute phase is modifying the training routine, after the acute phase. The goal of the treatment should focus on modifying training regimens and addressing biomechanical abnormalities. Following the subacute phase is stretching and strengthening exercises. Exercises should focus on strengthening the tibialis anterior and other muscles controlling both inversion and eversion of the foot. Strengthening of the core hip muscles may also be beneficial.

Other ways to treat shin splints is to have appropriate footwear. Shoes with sufficient shock-absorbing soles and insoles can reduce forces through the lower extremity and can prevent repeat episodes of shin splints. Orthotics can also help with biomechanical problems of the foot. Over-the-counter orthosis help with excessive foot pronation, and mal-alignments may benefit from custom orthotics.

Potential treatments may include extracorporeal shock wave therapy, which is used to treat various tendinopathies of the lower extremity, injection methods, which have been used to treat injuries of the lower extremity, including cortisone. There are also surgical options. These are reserved for recalcitrant cases who do not respond with conservative treatment. “Posterior fasciotomy” is the procedure performed. This may include cauterization of the posteromedial ridge of the tibia, and results may not cause complete resolution but can improve the pain and function.