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Calf & Shin Injuries

Calf & Shin Injuries

The lower leg consists of two bones and several muscles which control the movement of the foot and ankle. The two bones that make up the leg are the tibia and fibula. The tibia is on the inside of the leg and joins with the thigh bone to form the knee joint. Both the tibia and fibula form part of the ankle joint. Running down the back of the leg there are two muscles and the Achilles tendon.

Calf & Shin pain can be a serious problem for those affected, but there are a number of options available in terms of supports and braces to help limit its impact on daily life.

About the Calf & Shin

The larger gastrocnemius muscle runs from above the knee and connects to the heel through the Achilles tendon. The smaller soleus muscle sits below the gastrocnemius and also connects to the Achilles tendon. Both these muscles lift the heel to allow forward motion.

The Achilles tendon is the thickest and strongest in the body but is at risk to injury in sports involving bursts of activity. Bursts of activity in sport can be a root cause of many injuries, such a calf injury where damage to the muscle can occur as a result of failing to warm up properly before setting off on a run or a sprint up the wing on a football pitch. There are several muscles which run down the front of the fibula and they control the movement of the foot. As with all muscles and tendons, overuse can cause damage and lead to injury.

Two of the most common lower leg injuries among both amateurs and professionals alike include shin splints or muscle strains in the form of a calf injury.

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Types of Calf & Shin Injuries

Shin Splints

Shin Splints

Pain in the shins, following or during exercise is common. Typically, the pain will begin as a dull ache running down one, or more often, both shins.

This shin pain is known as shin splints, and ignoring the pain and continuing to exercise may cause the condition to worsen. Sufferers of shin splints should not attempt to exercise through the pain, as the discomfort could be an indication of injury, either to the bone or the adjacent tissues. It is advisable to discontinue the trigger activity for a minimum of two weeks until the pain has subsided.

Causes

There are a variety of causes for shin splints and shin pain. Medial Tibial Stress Syndrome (MTSS) is a common one. This is where the periosteum, the connective tissue covering the shin, becomes irritated and inflamed, usually as a result of excessive pressure on the shins. When an individual carries out new or intense exercise, MTSS can occur. Sports that require frequent stops and starts, such as tennis or netball can trigger MTSS, as can long-distance running. Over-pronation, where the foot rolls abnormally, can also put excessive and irregular force through the tibia and shin.

Diagnosis

If there is no improvement after two or three weeks of rest, or if the pain becomes worse, the GP may need to look into the problem further. Other causes of shin pain might include:

  • Stress fractures in the shin
  • A herniated muscle
  • Reduced blood supply
  • A problem with the nerves, either in the legs or the lower back
  • Compartment syndrome

It may be necessary to see a physiotherapist, who can provide an appropriate exercise and rehabilitation programme.

Management

Stop the activity causing the discomfort immediately. The pain should gradually subside and after about two weeks, it is usually possible to slowly resume the exercise. It is helpful to continue low impact activity during this time.

If there is any swelling, apply an ice pack to the shin for approximately ten minutes. This can be repeated twice or thrice hourly and will also help to relieve the discomfort. Paracetamol and ibuprofen, available over the counter, can be taken to reduce inflammation and pain.

Runners should ensure their trainers provide adequate support. Those with flat feet or with excessive over-pronation may require orthotics (shoe inserts) to correct the position of the foot. Specialist running shops often offer gait analysis and other tests and are able to provide advice accordingly. For more serious and ongoing problems, it may be necessary to consult a podiatrist.

Following two weeks of rest, it should be possible to gradually increase activity. It may take about three to six weeks to return to previous levels of activity. It is essential to warm up and warm down properly, before and after exercise.

To prevent shin splints and other shin pain in the future, it is important to build up exercise gradually. If possible, steer clear of hard surfaces when training and wear proper supportive running shoes and orthotics if necessary. Increasing general flexibility and strength will also help.

Calf Muscle Strain

Calf Muscle Strain

Causes

The calf consists of two muscles, the gastrocnemius and the soleus. The two muscles merge and connect to the Achilles tendon which, when the muscles contract, pulls the heel upwards to allow forward movement. As with all muscles the calf can become damaged when overstretched causing tears in the muscle fibres.

Symptoms

The severity of a calf muscle strain can range from a grade I strain where this little damage, it may initially feel like cramp but begins to hurt after finishing exercise. Grade II strains are more severe and the pain will be immediate, the muscle will be painful when stretched or contracted. A complete rupture of the muscle is a grade III tear. This will be much more painful and walking will be impossible without pain. There may also be a lump of muscle above the tear. Grade II and III tears will show bruising due to bleeding following the pulled calf muscle.

Management

Following the injury it is important to rest the muscle. Even if there is minimal pain it doesn’t take much more exertion for a calf strain to become more severe, it is much more sensible to rest and recover fully. Ice and compression can be used to help with pain relief and to reduce the swelling around the damaged muscle tissue. After an initial period of rest resistive training can start to begin again, at this stage calf supports can provide support to the muscle and confidence to the user. Less severe strains should heal within three to six weeks but a complete rupture may take months and require surgery for a complete rehabilitation.

Compartment Syndrome

Compartment Syndrome

Causes

Muscles, nerves and blood vessels are grouped forming compartments. These tissues are surrounded by fascia which aim to keep them in place, in order to do this the fascia is not easily stretched. Compartment syndrome describes the build-up of pressure within the muscles potentially decreasing blood flow.

In the lower leg there are four main muscle compartments, the most likely location of compartment syndrome is in the front compartment but it can occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks. When there is bleeding or swelling in the muscle this causes a build-up in pressure. As this pressure affects the blood flow within the muscle, and with it essential oxygen and nutrients, damage can be caused to muscle and nerve cells.

Symptoms

Compartment syndrome can occur acutely, following a severe injury like a broken bone or bad bruising. In this situation the build-up in pressure is extremely dangerous and surgery to release the pressure is the only treatment. With exertional lower limb pain the pain will be greater than would be expected from the injury itself, there may also be a burning sensation.

Management

Chronic compartment syndrome is less serious and is often found in people who carry out repetitive motions such as running or cycling. This can cause cramping and/or pain during exercise, although this usually stops with the end of activity. In some cases compartment syndrome occurs from exercising on certain surfaces such as AstroTurf, switching surfaces may relieve the symptoms. Other treatments include physiotherapy, shoe inserts and anti-inflammatory medicine. Often rest from the activity causing the pain is the best treatment.

Broken Leg

Broken Leg

A broken leg requires urgent medical attention so it is important to call an ambulance or get to the nearest A&E department as quickly as possible. Doctors will assess the degree of severity of the break or fracture and arrange appropriate leg support. Painkillers will be administered before X-rays are undertaken to determine the exact type of injury and arrange appropriate treatment.

Causes

You might hear the sound of a crack to indicate that a bone has been broken, but bruising, swelling and pain, particularly when accompanied by faintness or dizziness can all be signs of a break or fracture to a bone in the leg. A broken leg can happen following a fall, a bad sporting injury or a car crash to name but a few.

Symptoms

A broken leg can range in severity from a mild fracture which causes cracks in the bone, to a compound fracture where the bone breaks through the surface of the skin.

Management

The simplest form of fracture will usually be treated by the application of a plaster cast or other rigid brace which holds the bones in the correct position whilst healing takes place. Depending on the location of the break you may also be placed in a walker boot.

Where the bones have become misaligned the medical practitioner will administer some form of sedative and either localised, regional or general anaesthetic in order to realign the broken leg. Once any initial swelling has disappeared a plaster cast or support brace is applied to keep the leg steady while the bone knits together. Depending on the severity of the break the healing period can take anything from six weeks to several months.

Where a broken leg involves a severe compound fracture surgery may be required to fasten the broken pieces together. Using a variety of equipment including metal pins, plates, wires, rods and screws, the surgeon realigns the pieces of the break and fastens them together. Sometimes it is necessary to use an external framework in order to facilitate the healing process. Although external metal braces are removed once healing is complete it is usual to leave internal metal fixings in place unless they cause a problem.

Since it is important to avoid weight bearing activity on the broken leg the hospital or clinic will provide crutches for support and offer advice on recommended recovery times. These will depend on the severity of the injury and the age and condition of the patient, but it is important not to try to put weight on the affected leg before being given the go-ahead by medical professionals.

Once a cast or brace has been fitted to the affected leg an appointment is made to attend the local fracture clinic. Specialist orthopaedic doctors monitor and assess the healing process, taking further X-rays if necessary to ascertain how well the bones are knitting together.

Physiotherapy exercises will be provided once a broken leg is on the mend, often beginning before the plaster cast or leg support is removed. Pain often disappears before healing is complete, so it is important to pay attention to instructions from the fracture clinic regarding weight-bearing exercise in order to avoid any further complications.

Calf and shin pain can be a serious problem for those affected, but there are a number of options available in terms of supports and braces to help limit its impact on daily life.

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