Chief complaint: “Really bad shin splint, huge pain in legs”

HPI: A 16-year-old female presented to the clinic with bilateral lower leg pain. Her pain began during track season, approximately one month ago. The pain has progressively worsened so that it will continue after activity and will not subside until the next day if she continues to avoid activity.

She has tried icing and ibuprofen with minimal relief. The symptoms are worse in her right leg. Her activities include dance & track. She states a past history of similar type symptoms during the past track seasons however not this severe.

PMH: Non-contributory

FH: Non-contributory

SH: She works at a fast food restaurant. Denies smoking, drugs or alcohol use.

ROS: No symptoms suggestive of disordered eating; normal menstrual cycle; denied use of supplements and stated a well-balanced diet including fruits, vegetables, dairy, meats, grains and cereals; denied any fluctuations with her weight.

General: Medium height, slim, but not cachetic female appearing in no acute distress.

Vital signs : Height 5’6” weight 128 lbs.

Knees : Non-tender, no deformity, full ROM & strength.

Right shin : Generalized tenderness of anterior tibia, pain localized 10 cm proximal to medial malleolus, no deformity was appreciated, strength testing proved no abnormalities.

Left shin : General tenderness anterior medial tibia, no deformity was appreciated, and strength testing proved no abnormalities.

Ankles : stable, full ROM & strength, non-tender, no deformity.

Standing orthopedic : bilateral foot pronation, bilateral knees with out excessive valgus or varus, patella facing forward, hips level without excessive anteroversion or retroversion.

Initial Differential Diagnosis Based on the History and Physical: