Surgery for shin pain

Is surgery right for shin pain?

For most people, surgery is not the first or main treatment for shin pain. Common problems like medial tibial stress syndrome (often called shin splints) and many low grade tibial bone stress injuries usually improve with smart load changes, strength training, and time, without an operation. ^{2 6 7}

Surgery is usually only discussed when there is a more serious structural problem, such as:

• A high risk stress fracture in the tibia, especially on the frontal area, or a stress  fracture that is not healing with good protection and rehab. ^{1 3 6 7}
• Chronic exertional compartment syndrome with clear, repeatable symptoms and pressure testing that supports the diagnosis, after a good trial of non surgical care. ^{4 8 9}
• Very rare emergencies like acute compartment syndrome, where pressure in a leg compartment rises quickly and threatens the muscles and nerves, and urgent surgery is needed to save function. ^{4 5}

The decision to have surgery is never based on the scan alone. Your activity goals, medical history, bone health, and how you respond to conservative care all matter. Shared decision making with a sports medicine doctor or surgeon helps you understand likely benefits, risks, and other options before you choose. ^{1 4 6}

Common surgical options for shin pain

Not all shin pain problems have a surgical option, and many never need one. When surgery is considered, it is usually aimed at fixing a specific issue.

• Fixation of high risk tibial stress fractures. For stress fractures in higher risk areas, such as the front part of the tibia, or for fractures that are not healing, surgeons may use screws or plates to stabilize the bone. This is done to help healing and reduce the risk of complete fracture or nonunion. ^{1 3 6 7}
• Fasciotomy for CECS (Chronic Exertional Compartment Syndrome). In chronic exertional compartment syndrome, tight fascia (tissue) around the muscles can cause rising pressure with exercise. Fasciotomy is a surgery where the fascia is cut to give the muscles more room. This is usually considered when symptoms are clearly linked to CECS, tests support the diagnosis, and a time limited trial of gait and training changes has not helped enough. ^{4 8 9}
• Emergency fasciotomy for acute compartment syndrome. In rare cases, the leg becomes very tight and painful very quickly, often after trauma. This is an emergency because the blood supply and nerves can be damaged. Urgent fasciotomy is needed to relieve the pressure and protect the limb. ^{4 5}
• Treatment of other high risk bone stress injuries. Some shin pain patterns turn out to come from nearby high risk stress injuries, such as certain superior part of the thigh bone or navicular (foot bone) injuries. These often need early specialist input and sometimes surgery to stabilise the bone and avoid complete fracture. ^{1 6 7}

Your surgeon will only suggest these options if the benefits are likely to outweigh the risks for your specific situation.

What to expect during recovery

Recovery after surgery for shin pain depends on the exact procedure, the severity of the injury, and your overall health. There is no single timeline, but there are common phases. ^{1 4 6 7 9}

Right after surgery (days to the first couple of weeks)

• You may have a cast, boot, or bulky dressing to protect the leg. Weight bearing is often limited at first, especially after fixation of a stress fracture or emergency fasciotomy. ^{1 6}
• Pain, swelling, and bruising are common. You will receive a plan for pain relief, leg elevation, and gentle movement of nearby joints like the hip and ankle.
• After fasciotomy, wounds may be left partly open at first and closed later or covered with a skin graft. Staff will check circulation, sensation, and muscle function regularly. ^{4 9}

Early rehab phase (several weeks)

• You typically begin with gentle range of motion exercises and muscle activation exercises. The focus is on protecting the healing bone or soft tissues while preventing stiffness. ^{1 6 7}
• You may use crutches and a boot or brace. Your surgeon or physical therapist will guide when it is safe to increase weight on the leg.

Rebuilding strength and function (weeks to months)

• As healing progresses on clinical exams and sometimes imaging, rehab shifts toward building calf and soleus strength, foot and ankle control, and hip strength. ^{2 6 7}
• You gradually move from low impact exercise, like cycling or pool work, to higher impact drills such as hopping and, later, running. For CECS, gait retraining is often part of this phase. ^{2 4 8 9}

Return to running and sport

• A criteria based approach is usually safer than a simple time based rule. You and your clinician will look for pain free walking, no local bony tenderness, pain free hopping, and tolerance of early plyometrics before adding running. ^{2 3 6 7}
• Full return to sport after high risk stress fracture fixation or CECS surgery can take many months. Rushing back too fast can increase the risk of re injury or nonunion.^{1 2 6 7 9}

Possible risks and complications

Like any surgery, there are risks. These can include:

• Infection or delayed wound healing
• Bleeding or clots
• Ongoing pain, stiffness, or numbness
• Non-healing or delayed healing of the bone
• Incomplete symptom relief or recurrence after fasciotomy, especially in high demand groups like military personnel
• Scarring or cosmetic concerns at the incision sites ^{1 4 6 9}

Your team can help you understand how these risks apply to you and what can be done to reduce them.

Can surgery be avoided?

In many cases, yes. Most people with shin pain have medial tibial stress syndrome or low to moderate grade tibial bone stress injuries that respond well to conservative treatment when caught early. ^{2 6 7}

Non surgical care often includes:

1. Load management Reducing or pausing impact activities, cutting back hills and hard surfaces, and using a pain monitoring approach so that any symptoms stay mild and settle within a day. ^{2 6 7}
2. Strength and capacity building Targeted strengthening of the calf and soleus muscles, foot and ankle muscles, and hip and core helps your legs handle impact better. ^{2 6 7}
3. Addressing mechanics and shoes Improving ankle mobility, considering shock absorbing shoes, and using insoles or medial posting in some people with a pronated pattern can reduce tibial loading. ^{6 7 10}
4. Nutrition and bone health Checking for low energy availability, menstrual changes, low vitamin D, or other bone health issues is important, since these can slow healing and increase risk of future stress injuries. ^{6 7}
5. Time limited trial for chronic exertional compartment syndrome Some people with CECS patterns try gait retraining, load changes, and focused strength work first. If symptoms remain clearly limiting after a structured trial, then surgery can be discussed. ^{4 8 9}

There is also evidence from other musculoskeletal conditions that fully remote, exercise based digital care can produce similar improvements in pain and function as conventional face to face physical therapy, with high adherence and satisfaction. ^{11 12} While these studies are not specific to shin pain, they support the idea that a high quality digital rehab plan can be a safe and practical way to deliver conservative care when in person visits are hard to attend.

If you are wondering whether surgery can be avoided, a good first step is to get a clear diagnosis and commit to a structured, criteria based rehab plan. You and your clinician can revisit the question of surgery later if healing does not progress as expected.

How Sword can support you before and after surgery

Physical therapy can play an important role in preparing for surgery, supporting recovery, and, in some cases, helping people manage symptoms without surgery. Sword offers physical therapy programs designed to support you at different points along that journey.

Sword supports recovery before and after surgery, with care designed to fit into your life. You receive high-quality physical therapy at home, guided by licensed clinicians and supported by smart technology.

• Care that adapts as your body and recovery needs change
• Licensed physical therapists guiding your care at every stage
• Non-invasive, evidence-based physical therapy programs

Support for preparation, recovery, and long-term movement health

Clinical insight

The term “shin splints” is often used for any shin pain, but guidelines and expert reviews emphasise that it should not replace a clear diagnosis. Diffuse tenderness along the inner shin with pain only during impact fits medial tibial stress syndrome, which usually responds to load management and progressive strengthening. ^{2 6 7}By contrast, focal pinpoint tenderness, night or rest pain, or pain that does not ease with rest raise concern for higher grade bone stress injury, especially in the anterior bone. In these cases, early imaging and stricter protection are safer, and some may need surgical fixation if healing does not progress. ^{1 3 6 7} Using a criteria based, not purely time based, return to running helps tailor decisions to the actual healing response. ^{2 3 7}