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Laurel, MD 20707
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1360 Blair Drive Suite D 
Odenton, MD 21113
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5999 Harper's Farm Road, Suite W100 
Columbia, MD 21144
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Lower Leg

The lower leg, or shin, is composed of two bones. The tibia (the main weight bearing, or “shin” bone) and the fibula (the thinner outer leg bone). The lower leg connects the knee to the ankle and is an important attachment point for muscles that cross the knee and the ankle. Many of the muscles that control the foot and ankle originate in the lower leg, so it is highly correlated with foot and ankle pain.

Treatment of the lower leg will be based on your primary problem and will include:

  • A pain relief program and patient education on the lower leg (including its anatomy, risk factors for pain, and ways to manage pain in the short term at home)
  • Assessment of other joints/driving factors (leg length, gait, pelvic alignment, hip and ankle motion, etc)
  • Development of a home treatment program to speed recovery
  • Manual therapy (massage and hands-on stretching) to normalize range of motion and muscle tone
  • Exercise to improve movement and strength
  • Balance training as needed

Some common injuries of the lower leg:

Fracture: fractures may involve the outside (fibula) and/or inside (tibia) of the lower leg. Often time they are traumatic in nature, but in the case of stress fractures, (see below) they are linked to overuse. X-rays are essential and rapid “reduction” (setting the bones back in alignment for healing) is necessary. In most cases, the leg is then placed in a splint or cast and weight bearing is restricted for up to six weeks. In extreme cases, open surgery is necessary to reduce the fracture. Often pins, plates and screws are used to maintain the reduction. The Orthopedist will often prescribe physical therapy after the fracture has healed to address the weakness, loss of motion, and balance deficits that occur after immobilization and decreased weight bearing.

If a fracture is suspected, emergency medical treatment should be the first course of action. Symptoms may include:
  • significant pain
  • swelling and bony deformities at any point between the knee and ankle
Shin splints: are often described as a dull, achy pain along or just behind the tibia (shinbone) that increases with activity. Medically known as medial tibial stress syndrome, shin splints occur during physical activity and are the result of overuse (too much force being placed on your shinbone and the connective tissues that attach your muscles to the bone). This increased force causes these fibers to become irritated and inflamed. Shin splints are common in runners and in those who participate in activities with jumping, sudden stops and starts, and sprinting (basketball, soccer, tennis). Often the symptoms of shin splints can be improved with rest, muscle strengthening, stretching, and a change in footwear and/or running style.

Stress fractures: are often initially misdiagnosed as shin splints. As described above, the term shin splits is assigned to any discomfort on the inside/front of the shin. But the pain and discomfort may actually be something more severe. Stress fractures often occur with a sudden increase in training, a lack of rest/recovery between training sessions, or with repetitive impact on poor surfaces (pavement, concrete). Unable to manage the sudden increase in stress, the muscles transfer the workload to the bone. If the bone has not had sufficient time to adapt, it is susceptible to this overload of stress. When the bone tissue cannot withstand the additional force it experiences small, incomplete fractures can form.

Often appearing as “small cracks” on an MRI or bone scan (may be undetected on an x-ray), these fractures can progress to a full fracture if untreated. The bones that seem to be particularly susceptible to this type of injury are the tibia and in some cases, the metatarsals (foot bones). As with shin splints, most stress fractures are sustained during activities involving repetitive foot striking such as running. Distance runners experience the greatest incidence of this type of injury.

Symptoms may include:

  • a pain in the shin that increases with activity but also aches at rest, and may even throb at night
  • bruising/swelling along the shin and lower leg
  • radiating pain that begins in the shin and travels to the ankle or knee

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