Shin-splints: Common exercise-related syndromes affecting the lower leg

摘要

Lower leg pain is a common complaint of athletically active individuals, often limiting physical activities. As such, the group of lower leg conditions related to athletic pursuits and physical exercise confer considerable operational implications for the military. Whilst acute injuries to the lower limb are commonly encountered and are clearly of significance, this article focuses instead on chronic conditions related to physical activity. These include insults to bone such as stress fractures and medial tibial stress syndrome, and those related to the soft tissues such as chronic exertional compartment syndrome. In this article we will examine the presentation and management of these conditions. Introduction Despite the common label 'shin-splints', there are in fact many causes of exercise-induced lower leg pain, overwhelmingly linked to weight-bearing activity. Physical activities involving repeated large load transmission through the lower limb, such as long-distance running and extended marches with heavy equipment, are thought to contribute to the high rates of lower leg pain seen in military populations (1,2). It is important to note that a whole range of physical activities has been implicated in this group of conditions; one should not exclude these diagnoses in non-runners (2). Differential Diagnoses Chronic lower leg pain usually presents following an insidious onset, with symptoms of varying duration and severity (3). There are three main differential diagnoses to consider in a patient presenting with chronic exercise-induced lower limb pain: medial tibial stress syndrome, stress fracture, and chronic exertional compartment syndrome (4). In addition, one should consider other serious causes of lower limb pain, such as peripheral nerve compression, vascular insufficiency, osteomyelitis and malignancy (Box 1).