Treatment and prognosis differ widely for the various pathologies underlying exercise-related shin pain, so it is important to elucidate the exact cause.
‘Shin splints’ is a term that is frequently misused to describe any exercise-related leg pain, especially pain of the medial tibia. Exercise-related shin pain most commonly originates from the bone, periosteum and muscle compartments. A range of pathologies, from bone stress to stress fractures, may affect the tibia and, less commonly, the fibula. Medial tibial stress syndrome (also known as traction periostitis) is due to inflammation of the periosteum as a result of stress to the soleus muscle attachment and the fascia, which attach to the medial tibial border. Exertional compartment syndrome occurs when the deep posterior calf, anterior or lateral muscles, which are each encased in an inflexible fascia, become swollen and painful under exercise. There is often overlap between the conditions, and they can coexist.