Shin pain in an adolescent soccer player : A case - based look at “ shin

school soccer player, referred by her pediatrician, has been brought to the sports medicine clinic reporting a one-year history of “shin splints.” She describes shin pain in both legs that seems to increase with running and brisk walking, mostly over the “front” of her shins. She characterizes her pain as a “tightness” that “pinches” her legs and becomes noticeable five to seven minutes after she begins activity. The pain has become more intense the past two months—to the point where she is unable to run for more than 10 minutes at a time. The patient denies any history of trauma or of paresthesia or radiculopathy into the feet or toes. There is no history of foot drop. In the past two weeks, she has begun to limp when the shin pain is present. After she stops running, the pain disappears in five to 10 minutes. She has no pain at night or at rest. The medical history reveals mild asthma that is treated with a -agonist medication. She has no significant orthopedic history. Her dietary history is noteworthy for inadequate calcium intake (approximately 1,000 mg/day), and her menstrual history is remarkable for onset of menses at age 13. Since that time, she has had monthly cycles. There is no family history of osteoporosis. On physical examination, the gait is normal; there is no limp. She has moderate pronation of her feet with standing (Figure 1). She exhibits no bone tenderness in either leg upon palpation of the posterior-medial and anterior tibia (Figures 2 and 3).