Medial lower leg soccer injuries

Pain on the medial side of the lower leg can arise from the periost(periostitis), from the posterior deep muscle compartment(compartment syndrome), or from the tibia(stress fracture).

Periostitis(shin splints)

Periostitis of the medial margin of the tibia is a musculotendious inflammation. It is an overuse injury, which often afflicts football players when they change surfaces or shoes or when they increase the intensity of training and matches.

Symptoms and diagnosis

The symptoms are pain and tenderness over the distal margin of the tibia. The periostitis is often bilateral. Typically, the pain is intensive at the beginning of an activity and diminished after warm-up.

Treatment

The primary treatment is rest from the causative factor(s), until the tenderness over the tibia has disappeared. Surgery, in form of fasciotomy, may be necessary in chronic cases.

Posterior deep compartment syndrome

The muscles of the lower leg are enclosed in four compartments of connective tissue which are anchored to the tibia and fibula. Compartment syndromes are caused by increased pressure inside the compartments. Acute compartment syndrome can be the result from a blow or a kick to the calf and chronic compartment syndrome is a result of the increase of muscle bulk following training. The deep posterior compartment contains the flexor digitorum, flexor hallucis longus, and tibialis posterior muscles.

Symptoms and diagnosis

The major symptom of a posterior deep compartment syndrome is a gradually increasing pain at the medial margin of the tibia, sometimes associated with weakness and numbness of the foot.

Treatment

The treatment consists of rest, ice massage, anti-inflammatory medication, and, in chronic cases, surgery.

Stress fractures

Stress fractures are common overuse injuries in football players. The most common localizations are at the tibia and the fibula, but stress fractures are also commonly seen in the metatarsal bones, in the femur, and in the pelvic ring.

Symptoms and diagnosis

There is usually a sharp pain and a localized tenderness over the area of stress fracture. A fresh stress fracture is susually not visible on plain X-ray, but may be visisble as a subperiostal bone formation on a repeat X-ray 2-3 weeks after the onset of symptoms. A bone scan gives the definite diagnosis, but the clinical examination with a very localized, strong palpation tenderness, is usually enough for diagnosis.

Treatment

Tibial stress fractures usually do not require immobilization with plaster, but they do require complete cessation of running and other football activities for 6-8 weeks. Other activities, such as bicycling, swimming, and water-jogging, are recommended to maintain fitness and muscle strength. 

“Handbook of Sports Medicine and Science - Football(Soccer)”, Björn Eklbom