Overuse injuries are increasingly common in today’s society as children often practice the same sport throughout the year and for hours each day. Exercise-induced pain in the lower extremities is often a complaint of teenage athletes.  Lower extremity pain most commonly occurs from either a tibial stress fracture, medial tibial stress syndrome, or chronic compartment syndrome; the most common, medial tibial stress syndrome, is also known as shin splints. Pain from medial tibial stress syndrome is located at the mid to distal medial tibia. The pain is thought to arise from traction periostitis of the flexor digitorum longus and soleus muscles as they attach on the medial tibia; this disorder is also referred to as “soleus syndrome.”

Excessive pronation of the foot is the most common skeletal malalignment thought to contribute to medial tibial stress syndrome. Excessive pronation of the foot strains the soleus muscle, which acts to resist pronation. Conservative treatment with a period of rest and/or a decrease in training intensity is first-line treatment. Orthotics can help support a flat foot deformity.

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).


Woon C. Tibial stress syndrome (shin splints). Ortho Bullets. Accessed October 16, 2018.

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