Shin pain is a common complaint amongst athletes and in particular distance runners.

The term “shin splints” has been used to describe pain in this region, but it is somewhat misleading as it does not accurately describe the problem at hand and there are many different types of shin pain. Further it is common for shin pain to be the result of two or three separate pathologies occurring simultaneously.

Medial tibial stress syndrome is where inflammation develops at the insertion of muscles (tibialis posterior and soleus) to the inside edge of the tibia in the lower leg, a diagnosis traditionally referred to as “shin splints”.

Stress fractures typically present as sharp and very localised pain at a specific point along the shin bone. In severe cases immobilisation in a cast is required to give the bone a window of opportunity to repair.

Compartment syndromes can cause pain on the front and outside of the shin and also in the calf. The muscles of the lower leg are organised into compartments enclosed by inelastic connective tissues. When we exercise our muscles can swell by up to 20% of their volume. If these tissues enclosing the compartment are tight pressure within the compartment rises significantly putting pressure on nerves and blood vessels leading to symptoms including pain, burning sensations, pins and needles, and numbness.

Pain on the outside of the shin can often be due to entrapment of the superficial peroneal nerve, or referred from the lumbar spine.

Most shin pain is gradual onset and intimately related to a number of mechanical causes which if managed appropriately lead to successful recovery.

Over-pronation of the foot is a common underlying cause in all of the pathologies described above, and is often driven by variations in foot shape and structure (‘skeletal drivers’) such as an external tibial torsion, a rearfoot varus or forefoot supinatus, and hallux limitus. Other individuals present with a rigid foot type with limited shock absorption at heel strike, often associated with bone stress fractures. Gait analysis by an experienced podiatrist can identify these issues and determine whether intervention in the form of orthotic devices and/or running shoe advice is necessary.

Other underlying causes include lack of pelvis / hip muscle control leading to loss of limb alignment dynamically, and muscle imbalance in the lower leg, both of which are managed with specific exercises.