Rarely, blows to the tibia may cause a fracture. Much more commonly, these contusions cause a painful soft-tissue injury. This type of injury is seen in youth soccer or sports in which direct blows to the subcutaneous border of the anterior tibia causes hematoma formation. If the hematoma is subperiosteal, it causes severe pain and may result in a significant bony prominence in that area as it consolidates. The use of shin guards for soccer serves to almost eliminate this unless the shin guards are too short, in which case, contusions above the level of the shin guard can occur. While it is impossible to definitively rule out a fracture without a radiograph, percussion of the heel and gentle tor-sional stressing by rotating the foot may be helpful. Palpation of the noninvolved posteromedial aspect of the tibia may be nontender, thus supporting absence of a fracture. The contusion injury resolves with conservative care, and symptoms are in large part in proportion to the amount of bleeding. Careful padding speeds return to play and any resulting osseous prominence may be permanent.
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