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Health & Exercise Forum

Shin Splints

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Apr 7, 2010

Dr. Mackarey's Health & Exercise ForumGuest Author: Janet Caputo, PT, OCS

Shin splints are to runners what tennis elbow is to tennis players. The repetitive microtrauma of the heel/foot strike on the ground often leads to pain in the shins of runners, hikers and laborers. When shin pain lasts more than a day or two following the activity, it is

often referred to as a shin splint. Foot/leg alignment, footwear, surface type, mileage, speed and sudden change in training can all contribute to this dreaded problem.


There are two types of shin splints: anterior or front of the shin and medial or inner border of the shin. The anterior shin splints may occur with a rigid (supinated, high arched) foot, but either may result from a floppy, flat foot (pronated). Therefore, the mechanism of injury and evaluation of intrinsic foot biomechanics are pertinent pieces of information in order to initiate appropriate treatment.


Anterior shin splints are caused by overuse of the muscles located in the front of the lower leg (Tibialis Anterior, Extensor Digitorum Longus and Brevis muscles). This can occur in a high arched foot if the athlete runs on hard surfaces or downhill, but may also develop in a flat foot since the Tibilias Anterior muscle assists in controlling the arch. This athlete will experience pain at the lower 1/3 of the outer border of the lower leg which will increase when the muscles contract or are stretched. Your podiatrist or family physician must rule out a stress fracture and a compartment syndrome, which would require medical intervention.


Medial shin splints result from overuse of the muscles on the inside of the shin (tibialis posterior) creating a tendonitis from excessive flattening of the arch due to a flat foot. This occurs because the tibilias posterior muscle has the most effective control over this abnormal, excessive flattening of the arch. This athlete may report either a rapid increase in mileage or running on crowned roads or up steep hills. Pain will usually be experienced 4-6” above the inside ankle bone and may also be elicited with resistance applied to the tibialis posterior muscle.  Your podiatrist or family physician must rule out tarsal tunnel syndrome and stress fracture since they may present with similar symptoms.


Proper evaluation by a podiatrist and a physical therapist will determine if you are a rigid (supinated) or a flat (pronated) foot type. Once this determination is made appropriate treatment will begin.


If your foot is rigid and lacks shock absorption, you may benefit from:


  1. In the acute stage rest from sport, ice, oral anti-inflammatory, physical therapy using electrical stimulation (pain control), ultrasound and other modalities.
  2. Mobilization and stretching exercises to increase mobility of the soft tissues and joints which will encourage flattening of the arch and attenuate shock.
  3. Softer, accommodative shoe inserts (orthotics).
  4. Stable but cushioned shoes
    1. Bjorn
    2. Sketchers
    3. DocK Martins
    4. Merrels
  5. Accomodative, cushioned sneakers with extra rearfoot cushioning features (gel, air):
    1. Firm heel counter.
    2. Removable insole.
  6. Avoid hard outsole materials (pressed leather, hard rubber).


If your foot is flat and/or floppy, you may benefit from:

  1. In the acute stage follow recommendations for rigid foot.
  2. Taping techniques to support the long arch of the foot.
  3. Exercises to strengthen the muscles that provide dynamic support to the arch.
  4. Stretching tight structures that would encourage abnormal or excessive flattening of the arch]
  5. Strengthen weaknesses in entire lower leg
  6. Semirigid shoe inserts (orthotics).
  7. Stable shoewear that controls the arch.
    1. Mephisto
    2. Rockport
    3. Dansko
    4. Florsheim
    5. Ecco
    6. Naot
    7. Easy Spirit
    8. New Balance
  8. Motion control sneakers
    1. Straighter last.
    2. Insole: board last construction.
    3. Midsole
      1. dependent on body weight.
      2. Firmer midsole on inside with stabilization device.
    4. Reinforced and/or extended heel counter
    5. Removable insole.

In summary, to prevent the unwanted shin splints, be aware of foot type and shoewear as well as training regimen, surface, and intensity. If a foot abnormality is suspected, appropriate evaluation by your podiatrist or family physician with a referral to a orthopedic/sports physical therapist is needed to avoid future complications.


Visit your doctor regularly and listen to your body.


NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:


Janet M. Caputo, PT, OCS – guest columnist is an associate and clinic director at Mackarey Physical Therapy where she specializes in outpatient orthopedic and neurologic rehab. She is presently working on her doctorate in physical therapy from the University of Scranton.

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.