1) Shin splints – medial tibial stress syndrome – mid tibial or distal 1/3rd tibial pain, pain is present even before the start of the activity like running, diffuser tenderness over a wider area over tibia and tibialis muscle, risk factors are poor flexibility, over-pronation (pes planus), internal tibial rotation (look for tibial rotation in a seated patient with both legs dangling over the edge of the bed, both eyes focusing along the longitudinal axis of both tibia from above), worn shoes, running on hard surfaces,
2) Shin contusion – direct blow over the shin, ecchymosis, swelling,
3) Tibial Stress Fracture – commonest stress fracture, runners, dancers, and jumpers, very localized area of pain in the tibia, usually at the junction of middle and distal 1/3rd of the tibia, night pain, patient hopping on the affected leg severe pain at the site (this test is also positive with femoral shaft/pelvic stress fractures), Ix – Xray with cone down view, MRI tibia,
4) Chronic exertional compartment syndrome – leg pain, slow onset, usually bilateral, swelling of the affected limbs, predictable response for exercise – pain onset after the exercise, offset with 20 minutes of rest, pain recurs with exercise, risk factors are uneven exercise surface, worn out shoes, unacceptable training intensity, hindfoot pronation, Mx- Treat or modify the risk factors
5) Varicose veins – leg pain worse with prolonged standing and relieved by leg elevation, heaviness of legs, mild nakle edema, skin ulceration, hyperpigmentation, recurrent episodes of superficial venous thrombosis, dilated tortuous leg veins, Mx – periodic elevation of legs, avoid prolonged standing, elastic support hose, external compression stockings, sclerotherapy, surgical referral for intractable symptoms, recurrent superficial vein thrombosis, skin ulceration, cosmetic reasons.
6) Superficial vein thrombosis – leg pain along the course of a superficial vein, the red, warm, tender, palpable cord of a vein, surrounding redness and swelling, Mx – NSAIDs and antibiotics.
7) Recurrent bacterial lymphangitis – a patchy area of redness, warmth, swelling and tenderness, migrating proximally, with associated proximal site lymphadenopathy, distal leg swelling, and pain, maybe a precursor of lymphedema, Tx – NSAIDS, anti-streptococcal antibiotics
8) Chronic venous insufficiency – leg pain worsens on standing and relieved by leg elevation, increased leg girth, edemas, superficial varicose veins, erythema, dermatitis, skin ulcers (can occur near both medial and lateral malleoli), hyperpigmentation of skin, recurrent cellulitis, Mx – avoid prolonged standing, frequent leg elevations, graduated compression stockings, management of ulcers with wet/dry dressings with topical antibiotic solutions, and cellulitis with antibiotics.
9) Deep venous thrombosis – iliac, femoral, popliteal veins – unilateral painful leg swelling, warmth, redness, tenderness along the vein, palpable vein like a cord, increased tissue turgor, distended superficial veins, prominent venous collaterals, dark blue discoloration of the leg, Ix and Mx see below.
10) Deep venous thrombosis – calf veins – calf pain, swelling, posterior calf tenderness, warmth, increased tissue turgor, Homan’s sign positive (increased resistance or pain on ankle dorsiflexion), Ix – duplex venous ultrasonography, Doppler ultrasound, MRI, Mx – high risk for pulmonary embolism, chronic venous insufficiency, medical referral for further management.