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Musculoskeletal Imaging

E3084. Running Injuries of the Lower Leg

Abdelhadi S,  Daruwalla V,  Dustin C,  Loveridge ,  Al-Hihi M. Wayne State University, Detroit Medical Center, Detroit, MI

Address correspondence to S. Abdelhadi (

Background Information: Running is quickly becoming the most popular sport in the United States, with over 7 million 5-km race finishers, and half-million full marathon finishers (42 km) in the past year alone. Lower leg pain in the beginner runner and professional athlete alike is a very common presentation secondary to overtraining. These injuries vary from tendonitis, plantar fasciitis, medial tibial stress syndrome (MTTS) commonly known as shin splints, and the dreaded stress fracture, which requires immediate cessation of exercise and immobilization.

Educational Goals/Teaching Points: This educational exhibit thoroughly reviews the following: running biomechanics, relevant anatomy of the lower leg, pathophysiology of plantar fasciitis, MTTS, and stress fractures. Their imaging appearance on ultrasound, plain radiographs, CT, NM bone scan, and MRI will be discussed along with their respective sensitivities. The Fredericson grading system for MTTS on MRI will be detailed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We describe the pathophysiology and radiographic findings of lower leg running-related injuries such as plantar fasciitis, shin splints, stress tibial diaphyseal stress fractures, and tendonitis on multiple modalities.

Conclusion: With the increased popularity of running, it is important for the radiologist to have a solid knowledge of common lower leg injuries and be able to adequately diagnose various pathologies and relay information to the clinician in order to start appropriate management. In athletes, it will also dictate appropriate rest and training regime.