Is it Shin Splints or Compartment Syndrome? Why Getting the Correct Diagnosis Is Essential

shin pain specialistIf you are a runner or engage regularly in athletic activity that includes running, odds are you are quite familiar with shin splints—pain in your legs that comes on during your run and makes it difficult to continue. Even if you have never experienced shin splints personally, you probably know someone who has.

You might be less familiar, however, with compartment syndrome. This is a condition that can easily be mistaken for shin splints but requires significantly different treatment.

Shin Splints vs. Compartment Syndrome

Let’s look at the key differences between shin splints and compartment syndrome.

One of those differences has to do with the location of the pain you experience. If you are dealing with shin splints, the pain will be on the inside front of the leg. Conversely, pain caused by compartment syndrome is experienced on the outside front of the leg.

Timing is another telling difference. The pain from shin splints may arise from activities other than exercise. That pain worsens during exercise and then subsides after you stop your vigorous activities. On the other hand, pain that is the result of compartment symptom starts during exercise and may linger for a long time after you stop exercising.

Compartment Syndrome is most often described as an intense "pressure" being built up in the muscle groups.  It is often very intense, and many patients describe that it feels like their "legs are going to explode." As the pressure builds the legs may feel "swollen" or full. This is typically when many patients will experience numbness to the top and bottom of the foot, depending on which of the four compartments is involved. Also, if patients continue to run and the pressure continues to build they may experience weakness to the point where they can not lift or stabilize the foot, or pushing off may become impossible, until they rest the leg. They may describe the foot as feeling "clumsy."

Finally, shin splints have no symptoms related to nerves. But symptoms of compartment syndrome include numbness and/or tingling on the top of the foot.

Different Conditions Require Different Treatments

When it comes to shin splints, treatments are straightforward and non-invasive. They may include stretching and strengthening, shoe and training changes, and corrections to biomechanics. Shin splints also are treated with lots of ice and rest, and athletic taping of the shins by an athletic trainer. It can be sharp, tearing pain down the anterior medial shin.

For compartment syndrome, however, the first step is a lengthy period—often several months—of complete rest from running and other similar exercises. That period of rest is generally followed by a program that includes stretching and strengthening as well as biomechanical corrections. If that does not fully address the issue, compartment syndrome may have to be corrected via surgery.

Often times to make the diagnosis, patients must have the pressures measured in the compartments before or after activity when symptoms are present. This is done with a needle or a catheter to measure the pressure within the muscle compartment. When I decompress the compartments, I make a very specific point to identify the sensory nerves that get compressed when the pressure is high and release the nerves while I am releasing the compartments.  We do this because we have treated many patients who had a compartment release, but who still have symptoms of numbness and weakness in their legs. There are many patients who are then written off as "failures" of treatment because they did not get better. In reality, they are failures of diagnosis or "complete" diagnosis. The treating doctors may have diagnosed the compartment syndrome, but missed the specific nerve compression that also exists. If you are a patient who has had compartment syndrome, AND you are continuing to have symptoms of numbness or weakness in the legs or feet be sure to contact our office. We will be happy to examine you for the possibility of compression of the common peroneal nerve, superficial peroneal nerve, and deep peroneal nerve. These nerves go to to the top of the foot.   

The tibial nerve at the calf and the ankle -- if compressed and not properly released while doing these procedures -- can lead to persistent numbness and tingling to the sole of the foot and weakness in toe flexion.  
One other interesting fact that may seem pretty straightforward is that it is possible to release the compartments without releasing the compression on the nerves. However, it typically not possible to do a real release of the nerves without releasing the compartments. Frequently, surgeons without a good peripheral nerve background "like to leave the nerves alone" and therefore if someone does have a nerve compression in addition to a true compartment syndrome, this diagnosis gets left untreated.   

The Correct Diagnosis Is Essential. Contact Our Baltimore Nerve Pain Specialist Today.

Because the treatments are so different, it is absolutely essential that you get the right diagnosis so that you know whether you are dealing with shin splints or compartment syndrome. Dr. Eric H. Williams has the expertise and experience necessary to make the correct diagnosis and then get you on the road to recovery. If you are experiencing pain when you run, contact us today.

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.
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