Comparison of features of chronic exertional compartment syndrome and medial tibial stress syndrome (shin splints)

chronic exertional compartment syndrome (CECS)

medial tibial stress syndrome (MTSS)

Nature of pain

Aching, burning or cramping pain

Diffuse pain of variable intensity

Relieving and exacerbating factors

Pain due to chronic exertional compartment syndrome typically follows this pattern:

• begins after a certain time, distance or intensity of exertion after you start exercising
• progressively worsens as you exercise
• subsides within 10 to 20 minutes of stopping the activity
• over time, recovery time after exercise often increases

Exacerbated by exercise, relieved by rest

Most common location of pain

Anterior compartment of the lower leg is the most commonly affected

Middle to distal posteromedial border of the tibia

Unilateral or bilateral

Bilateral more common

Bilateral more common

Neurovascular changes

Paraesthesia and/or numbness of leg and foot reported on exertion

None

Associations

• diabetes mellitus
• recent change in footwear or exercise regimen
• wearing of high heels
• pes planus

• often pain worse in the morning
• improper footwear
• exercising on a hard surface, uneven terrain
• pes planus

Physical examination

• examination normal at rest
• during and immediately after exercise
  • affected area may bulge with paraesthesia and numbness of the compartment or the foot

• pitting oedema may be present over the affected area
• pain on palpation during both rest and exertion
  • periosteal tenderness at the distal 1/3 to 1/2 of the anteromedial tibial surface