by William J. Doherty, M.D.

A. The shinbone supports the majority of the body’s weight, so lower leg pain is a fairly common complaint. Your problem may be related to the bone itself or to the muscles, tendons or tissues surrounding it.

Cause 1: Shin Splints
Pain Description: Shin-splint pain may be more intense when an exercise session begins, then subside a little.

Reason: Tendons connect muscle to bone through fibers. Pulling at these fibers too hard or for too long—or when the muscles haven’t been stretched enough—can cause microscopic tears.

Prevention: Stretching before and after exercise can help prevent or reduce the pain. Also, be sure to wear a well-fitting, supportive athletic shoe with plenty of cushion and a good arch support.

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Cause 2: Stress Fractures
Pain Description: This condition is usually very painful, and continued activity only causes more pain.

Reason: A stress fracture is a microscopic crack, more common in women, that occurs when the shinbone isn’t strong enough to handle the load the body’s putting on it. Excessive running or even excess weight, for example, can cause a stress fracture.

Treatment: You’ll need rest and bone protection until the crack heals. It’s important that your health-care provider guide you through this process.

Cause 3: Poor Circulation
Pain Description: If the pain is in your calf rather than your shin, poor circulation could be the culprit.

Reason 1: Muscles rely on blood to bring in enough oxygen. Activity increases their need. If your legs aren’t getting enough oxygen, you may have a dull, aching calf pain. Atherosclerosis (hardening of the arteries) can cause poor circulation. Diabetics are particularly prone to this condition.

Reason 2: A more rare but also serious possibility is chronic compartment syndrome, which usually occurs in highly trained athletes. Tough yet flexible tissue-envelopes, or fascia, surround leg muscles and divide them into compartments. Extra muscle work and blood flow during exercise increases the pressure in these compartments. But rarely, the pressure gets abnormally high and actually impedes that blood flow. At this point, muscle fibers can die. Pain from chronic compartment syndrome is usually deep, sharp and intense.

Treatment: Your health-care provider can check you for any of these conditions and get you started on a treatment plan. You may need surgery to correct chronic compartment syndrome.

WILLIAM J. DOHERTY, M.D. is a board-certified orthopedic surgeon with Orthopedic Surgery in Melrose, Mass., and president of the Melrose-Wakefield Hospital medical staff.

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