The shin splint syndrome is classified according to the cause and location of the pain:

1. **Medial Tibial Stress Syndrome (MTSS):** Pain occurs along the inside of the shin, usually due to overuse of the muscles or tendons.

2. **Compartment Syndrome:** Increased pressure in the muscle compartments of the lower leg, leading to pain and circulatory disorders.

3. **Stress Fractures:** Microfractures of the shin due to repeated stress, a more severe form of shin splints.

4. **Acute Shin Splint Syndrome:** Sudden onset of pain, usually after intense physical activity.

5. **Chronic Shin Splint Syndrome:** Prolonged pain that can also persist at rest.

The causes of shin splints are varied and include mechanical, muscular, and external factors:

- Mechanical factors:

- Misalignments of the foot such as overpronation or flat feet, which increase the load on the shin.

- Insufficient shock absorption due to worn-out shoes or hard running surfaces.

- Muscular overload:

- Repeated, intense activities such as running, jumping, or dancing.

- Imbalances between the calf and shin muscles.

- Bone stress:

- Microtraumas to the shin due to inadequate recovery periods.

- External factors:

- Sudden increase in training intensity or duration.

- Training on uneven or too hard surfaces.

The symptoms vary depending on the severity and progression of the disease, but typically include:

- **Pain:** Dull or stabbing pain on the inside of the shin, which intensifies with exertion.

- **Tenderness:** Pain when palpating the shin.

- **Swelling:** Slight swelling along the affected area.

- **Movement restrictions:** Pain may limit running or other athletic activities.

- **Pain progression:** Initially, pain occurs only during exertion, later also at rest.

The diagnosis is made through a combination of medical history, clinical examination, and, if necessary, imaging techniques:

• Medical History:
  • The doctor inquires about the type of sports activities, training intensity, and duration of symptoms.
• Physical Examination:
  • Palpation of the shin to locate the pain.
  • Tests to assess foot misalignments or muscle imbalances.
• Imaging:
  • X-ray: Exclusion of stress fractures.
  • MRI: Detailed depiction of soft tissue and bone structures.
  • Bone Scintigraphy: Detection of stress reactions in the bone.

Conservative Therapy

The treatment aims to relieve pain, promote healing, and prevent future complaints:

• Shockwave Therapy (ESWT):
  • Direct inhibition of inflammation and promotion of tissue regeneration.
• Immobilization and Relief:
  • Reduction or temporary cessation of sports activities.
• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
• Physiotherapy:
  • Stretching and strengthening exercises for the shin and calf muscles.
  • Manual therapy to improve mobility and circulation.
• Cold and Heat Applications:
  • Cold treatment for pain relief in acute phases, heat therapy for muscle relaxation.
• Shoe Supply:
  • Use of shock-absorbing insoles or special sports shoes.

Surgical Therapy

In rare cases, with chronic complaints or complications:

• Fasciotomy: Relief of muscle compartments in compartment syndrome.
• Corrective Surgeries: Treatment of foot deformities.
• Fixation in Stress Fractures: Stabilization of the shin in severe fractures.

To prevent shin splints, the following measures are recommended:

1. Proper running technique: Avoid overpronation and excessive impact.
2. Suitable footwear: Shock-absorbing sports shoes or insoles for misalignments.
3. Training adjustment: Gradual increase in training intensity and duration.
4. Muscle strengthening: Strengthening of the calf and shin muscles through targeted exercises.
5. Regular recovery phases: Avoid overloading by taking sufficient breaks.