What are the treatments for intractable shin splints?

From the Guidelines

Intractable shin splints should be treated with a comprehensive approach that includes complete rest, ice therapy, anti-inflammatory medications, physical therapy, and proper footwear, with consideration of extracorporeal shockwave therapy or surgical interventions in severe cases. The treatment of intractable shin splints requires a multifaceted strategy to address the underlying causes of the condition and promote healing.

Initial Treatment

• Complete rest from the aggravating activity for 2-4 weeks is essential to reduce stress on the affected area.
• Ice therapy should be applied for 15-20 minutes several times daily, especially after any activity, to help reduce inflammation and pain.
• Anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) can help manage pain and inflammation, as seen in the treatment of heel pain 1.

Physical Therapy and Footwear

• Physical therapy focusing on strengthening exercises for the anterior tibialis muscle, calf stretches, and proprioception training is essential to improve muscle function and reduce stress on the affected area.
• Proper footwear with adequate arch support and shock absorption is crucial, and custom orthotics may be necessary for those with biomechanical issues, similar to the use of customized orthotic devices in the treatment of heel pain 1.

Advanced Treatment Options

• For truly intractable cases, extracorporeal shockwave therapy (ESWT) may be beneficial, typically administered in 3-5 sessions over several weeks, as mentioned in the context of treating heel pain 1.
• In rare cases where conservative measures fail and MRI confirms severe periostitis or stress fractures, surgical interventions like fasciotomy may be considered, as a last resort for treating intractable cases 1. It is essential to note that the treatment approach should be individualized based on the patient's specific needs and circumstances, and referral to a specialist, such as a podiatric foot and ankle surgeon, may be necessary if no improvement occurs after six weeks 1.

From the Research

Treatments for Intractable Shin Splints

• Conservative treatment options for medial tibial stress syndrome (MTSS), commonly known as "shin splints," include a variety of approaches, as discussed in 2.
• The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain, as stated in 3.
• A novel physical therapy approach has been proposed for pain management and enhancement of performance in shin splints athletes, as described in 4.
• Foot orthoses have been shown to enhance the effectiveness of exercise, shockwave, and ice therapy in the management of MTSS, as reported in 5.
• Rest, ice, compression, and elevation (RICE) is a common treatment approach for reducing swelling, and the addition of negative pressure (RICE+) may also be beneficial, as investigated in 6.

Conservative Treatment Options

• Expert opinion and clinical experience are often the basis for current treatment options, as noted in 2.
• Avoiding excessive stress and repetitive strain can help prevent MTSS or shin splints, as discussed in 3.
• A multimodal therapeutic intervention, including ice massage, ankle muscle exercises, and extracorporeal shockwave therapy, may be effective in managing MTSS, as reported in 5.

Novel Approaches

• A case report has described the use of a novel physical therapy approach in a long-distance runner with shin splints, as presented in 4.
• The use of arch-support foot-orthoses (ASFO) has been shown to add benefits to a multimodal therapeutic intervention in the management of MTSS, as reported in 5.