Jock Doc

Getting to the bottom of shins pain

Q. I am a runner who has had pain in my shins for more than six months. Initially I thought the pain was shin splints and tried to run through it. Over the last two months when I run the pain goes from my shin into the top of the foot. I also have numbness on the top of my foot and into my toes. When I stop running after a few minutes it goes away and I feel normal. I have tried running on softer surfaces and even changed my running shoes but the problem persists. I went to my family doctor, who took X-rays and said nothing was broken and that if I rested, the pain should go away. It is not going away and I wondered what I should do next.

I recommend you see an orthopedic surgeon for evaluation of your shins. A stress fracture is a microfracture of the bone that may not appear on an X-ray. If the doctor finds that you have discomfort in the region of the tibia or fibula bone in the shin, then he or she may order an MRI scan, which is usually accurate in diagnosing a stress fracture.

The more likely cause of your symptoms is a less common injury known as chronic exertional compartment syndrome. This is a condition caused by the lining of the muscles being too tight and constricting the muscles while running. The athlete will usually complain of pain in the front part of the shin with pain or numbness radiating to the top of the foot and toes. This usually resolves quickly when the athlete stops running. The syndrome could also be present in the calf muscles as well.

Exertional compartment syndrome is usually not evident on routine testing and MRI scans. Special compartment pressure measurement tests may be necessary pre- and post- exercise performed by your physician to accurately diagnose the condition.

For the high-level athlete who does not want to give up running or other sports, surgery may be necessary to decompress the constricted lower leg compartments. The success rate is usually quite high

This condition is also common in dancers, soccer, and I even treated a professional baseball umpire for it.

Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to

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