Inflammation of the inner shin bone


(Periostitis tibialis medialis, “Shin splint”)

The calf muscles are divided in three muscle groups (compartments) by powerful muscle membranes (fascie). A forward, an exterior and a rear muscle group (which is divided into a superficial and a deep part). The large rear muscle groups’ muscle membrane (fascie) is fastened on the inner edge of the shin bone (tibia), while the forward muscle group is fastened on the external edge of the shin bone (Photo).

Cause: In cases of repeated uniform loads, a stress related inflammation can occur where the muscle membrane fastens on the edge of the shin bone. The condition is most often seen in athletes with a tendency to rotate the foot outwards (hyperpronation) or with a high foot arch. Frequent change of running surface or shoes increases the risk.

Symptoms: Pain on the inner edge of the shin bone, aggravated upon applying pressure, load (running) and stretching in the foot joint against resistance (flexion). The pain is often localized to the lower part of the shin bone. Sometimes an irregular bone edge can be felt on the shin bone.

Acute treatment: Click here.

Examination: In light cases medical examination is not necessarily required. In cases with more pronounced pain or lack of progress despite relief, medical examination is recommended to ensure the diagnosis and rule out amongst other things a stress fracture. A normal medical examination is usually sufficient in order to make the diagnosis. In some cases it may be necessary to supplement with X-rays, scintigraphy or ultrasound scanning.

Treatment: The treatment comprises relief, stretching and slow rehabilitation. It is imperative that there are good shock absorbing soles in the shoes. In cases where there is a lack of progress the treatment can be supplemented with a medical treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid (which is always a part of a longer lasting rehabilitation). In severe cases with no effect from relief, correct rehabilitation and medical treatment, you can surgically split the membranes (fasciotomy) which fasten on the edge of the shin bone (article).

Complications: If the course does not progress smoothly, you should be medically re-examined to ensure that the diagnosis is correct, and that complications have not arisen in the form of stress fracture.

Special: Shock absorbing shoes or inlays will reduce the load. In case of lack of progress or relapses after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style is indicated.