Differential Diagnosis for Anterior Leg Pain with Running

• Single most likely diagnosis
  • Shin splints (Medial Tibial Stress Syndrome): This is the most common cause of anterior leg pain in runners, resulting from repetitive stress and overuse of the muscles and bones in the lower leg.
• Other Likely diagnoses
  • Compartment syndrome: A condition where pressure within the muscle compartments increases, leading to pain, especially with exertion like running.
  • Stress fractures: Small cracks in the bone, often caused by overuse or repetitive stress, which can cause pain that worsens with activity.
  • Periostitis: Inflammation of the periosteum, a layer of connective tissue that surrounds bone, which can be caused by running and lead to anterior leg pain.
• Do Not Miss diagnoses
  • Deep vein thrombosis (DVT): Although less common, DVT is a potentially life-threatening condition that can cause leg pain and should not be missed, especially if there are risk factors such as recent travel, immobilization, or family history.
  • Osteomyelitis: A bone infection that can cause pain, fever, and other systemic symptoms, which, although rare, requires prompt diagnosis and treatment to prevent serious complications.
• Rare diagnoses
  • Popliteal artery entrapment syndrome: A rare condition where the popliteal artery is compressed, leading to leg pain during exercise.
  • Nerve entrapment syndromes (e.g., peroneal nerve compression): These can cause pain, numbness, or weakness in the leg and are less common causes of anterior leg pain in runners.
  • Bone tumors: Although extremely rare, bone tumors can cause leg pain and should be considered if other diagnoses are ruled out and pain persists or worsens over time.