05/05/2019
Calf and lower leg pain is a common complaint of athletes both young and old. What makes them often difficult to treat is that these pains often come on gradually and often can be 'played through'. This leads athletes to assume that they problem is just shin splints and don't need evaluation or specific care. However, the other two common diagnoses of calf pain that comes on gradually, stress fractures and compartment syndrome, can lead to long treatment courses when not diagnosed early and correctly. Additionally, shin splints when not treated can also lead to long periods of not performing at a high level.
Each of these three problems - shin splints, stress fractures, and compartment syndrome - come on without a single specific injury and often have very non-specific, general pains. Shin splints are most common in athletes participating in sports that require long period of running. Initially a mild calf tightness will be present and then if left untreated the pain becomes more localized along the edge of the tibia over an area of a few centimeters to several inches. While rest and stretching often is all that is needed to treat this problem known as tibial periostitis, in-season athletes are stuck 'limbing through the season'.
Concerning is when the pain is assumed to be shin splints but is actually more serious.
Compartment syndrome. for instance, when untreated can lead to debilitating pain that comes on after 15-20 minutes of running and forces the athlete to stop. Though the etiology is often unknown it is thought that after a period of rest, stretching, and attention to nutritional factors early compartment syndrome can resolve. Later on, compartment syndrome becomes more established and it does not matter what an athlete does, the pain comes on every time an athlete attempts to return to activity. In these cases in order to return to their sport or previous activity level the only option is to release the fascia (fasciotomy) around the muscles to relieve the symptoms.
Similarly, stress fractures come on gradually and often progress from a stress reaction to a stress fracture. When recognized and diagnosed early, a short period of rest and limiting offending activities, a stress reaction will heal/resolve and an athlete will be able to return to full activity. However, once a stress reaction progresses to a stress fracture more significant treatment is required including long periods of non-weight bearing or protected weight bearing. As opposed to shin splints which have pain over an area along the ridge of the tibia, stress fractures have very focal, pinpoint pain. When this type of pain is present a x-ray or MRI can confirm the presence of a stress fracture and appropriate treatment instituted. Failing to diagnose a stress fracture and care for them appropriately can lead to a protracted treatment course and even in extreme cases operative intervention.
