Lower Leg Pain Differential

Diagnosis
A Selection of Musculotendinous Causes
ACHILLES TENDINOPATHY
Description
● Achilles tendinopathy is a painful overuse injury of the Achilles tendon.
● Inflammation (tendonitis) may or may not be present.
Causes
● Degeneration or failed healing from continuous overload without necessary rest
● Sudden changes and increases in exercise or work intensity or duration
ACHILLES TENDINOPATHY
Risk Factors
● Decreased plantar flexor strength
● Decreased hip neuromuscular control
● Abnormal ankle dorsiflexion and subtalar range of motion
● Increased foot pronation
● Increased body weight
● Systemic disease
● Genetic variants
● Family history of tendinopathy
● Fluoroquinolone antibiotic use
● Possible link to footwear, sports, and environmental conditions
MUSCLE STRAINS
Description
● A muscle strain is specific to the tissue of muscles or tendons. It involves the tissue
that connects muscles to bones and includes a range of injury severities. Muscle
strains may be as minor as a slight overstretch of the musculotendinous tissue or may
be as serious as a full tear of the musculotendinous tissue.
MUSCLE STRAINS
Causes
● Poor body mechanics
○ Lifting
○ Running
○ ADL’s
● Repetitive stress
○ Same motion
○ Quick change in direction
○ Fatigue
● Overuse
○ Excessive stretch of muscles and/or tendons
MUSCLE STRAINS
Treatment
● Resting the affected area (lower leg) so avoiding any activity that requires
considerable activation of lower extremity such as running, jumping, and lifting
● Massage can be used to decrease inflammation along with reducing tense muscles in
the affected area that could possibly add to future strains
● Anti-inflammatory medication to reduce swelling and inflammation in the affected
area
● Later treatment may include a combination of stretching and light exercise to bring
back strength and elasticity to the injured tissue
Shin Splints
Description
● Shin splints, also known as medial tibial stress syndrome, are quite common and are
an overuse injury that is specific to the lower leg. This injury is common to
individuals in a high demand environment such as athletes and individuals in manual
labor or the military. The pain sites associated with the injury are the anterior tibia
and posterior tibia. It has been shown, in some cases, to be related to tibial stress
fractures. More specifically shin splints are pain and inflammation associated with
microtears in the musculotendinous connections to the tibia.
Shin Splints
Causes
● Any activity that causes repetitive stress to the tissue that connects the muscle to the
bone called the periosteum.
● This condition is what is known as periosteum and when it occurs on the anterior or
posterior tibia it is called shin splints.
● Risk Factors
○ High activity profession
○ Exercise
○ High arches
○ Flat feet
Shin Splints
Treatment
● Rest is the top priority for an individual recovering from shin splints because the
underlying cause of the injury is overuse. Ice is a common treatment modality and
allows for a decrease in the level of inflammation and pain. The use of non-steroidal
anti-inflammatory medications is also common. The change in shoes especially by
adding support and orthotics can help an individual that is experiencing symptoms
stemming from improper footwear. Progression of strength using exercises focused
on the anterior lower leg along with stretching modalities in the same body region are
also common.
References
McClure, C. J., & Oh, R. (2022). Medial Tibial Stress Syndrome. In StatPearls. StatPearls Publishing.

http://www.ncbi.nlm.nih.gov/books/NBK538479/

Reinking, M. F., Austin, T. M., Richter, R. R., & Krieger, M. M. (2016). Medial Tibial Stress Syndrome in

Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health, 9(3),

252–261. https://doi.org/10.1177/1941738116673299

​Winkelmann, Z. K., Anderson, D., Games, K. E., & Eberman, L. E. (2016). Risk Factors for Medial Tibial

Stress Syndrome in Active Individuals: An Evidence-Based Review.

References
Dos Santos Franco, Y. R., Miyamoto, G. C., Franco, K. F. M., de Oliveira, R. R., & Cabral, C. M. N. (2019).

Exercise therapy in the treatment of tendinopathies of the lower limbs: A protocol of a systematic

review. Systematic Reviews, 8(1), 142. https://doi.org/10.1186/s13643-019-1058-9

Silbernagel, K. G., Hanlon, S., & Sprague, A. (2020). Current Clinical Concepts: Conservative Management

of Achilles Tendinopathy. Journal of Athletic Training, 55(5), 438–447. https://doi.org/10.4085

/1062-6050-356-19
References
Meulenkamp, B., Stacey, D., Fergusson, D., Hutton, B., Mlis, R. S., & Graham, I. D. (2018). Protocol for

treatment of Achilles tendon ruptures; a systematic review with network meta-analysis. Systematic

Reviews, 7(1), 247. https://doi.org/10.1186/s13643-018-0912-5

Hsu, D., & Chang, K.-V. (2022). Gastrocnemius Strain. In StatPearls. StatPearls Publishing.

http://www.ncbi.nlm.nih.gov/books/NBK534766/