Struggling with shin pain? Worried it’s “Shin Splints”? Podiatrist Mitchell Paterson discusses likely causes, treatments and prevention

By: Mitchell Paterson, B. Health Science (Podiatry) (Hons)
Supervising Podiatrist, My Foot Dr Tweed Heads

Shin splints – sounds scary doesn’t it?! But there’s no need to be alarmed – the vast majority of
people that experience shin splints get back to the things they love doing by listening to good
advice and following an individualised management plan. At the very least, shin splints shouldn’t
be ignored – the typical just ‘run through it’ will unfortunately make things worse. In this blog, we
explore what shin splints are, delve into factors thought to increase the risk of experiencing shin
splits and discuss options for management. We’ll also shed light on the crucial role that podiatry
plays in managing and helping to reduce the risk of shin splints, including the potential role of
custom foot orthotics and shockwave therapy.

What are shin splints?

Shin splints is a common condition that affects athletes and active individuals. The medical term
for shin splints is medial tibial stress syndrome (MTSS). The term “shin splints” refers to pain
along the inner edge of the shinbone (the tibia). Whilst the cause of the pain is not exactly
known, it is thought to arise from inflammation and muscular traction of the tissues surrounding
the tibia.
Shin splints is often associated with repetitive stress and overuse, particularly in activities that
involve running, jumping, or sudden changes in direction. The pain typically occurs along the
inner border of the tibia, in the lower third of the leg. It is important to address shin pain
because, if left untreated, it can progress to a stress fracture which requires a much longer
rehabilitation time.

Factors thought to contribute to shin splints:
Too much, too fast, too soon

Most commonly, shin pain is directly related to training loads. Simply – doing too much, too fast,
too soon. Doing too much and/or too fast and/or too soon doesn’t allow sufficient time for
conditioning – the adaptation of the muscles and bones overtime. For example, MTSS might
occur in a novice runner who too quickly increases their running kilometers only to start
experiencing pain a few weeks into their exercise program.

Female athlete triad

The female athlete triad is a complex syndrome involving the interrelationship of menstrual
dysfunction, low energy availability (with or without an eating disorder), and decreased bone
mineral density. What does this mean in simple terms? When women don’t eat enough
nutritionally dense foods for the amount of exercise that they are doing, their body reacts
differently to males. One such complication is hormone imbalances, which cause irregular
periods, another is reduced bone density. Both of these factors increase injury risk. Whilst shin
splits are not directly a component of the triad, there are connections between the triad and
factors that may contribute to the development of shin splints in female athletes (Kuwabara et al
2021). Addressing the female athlete triad requires a multidisciplinary approach as well as
modifying training regimens to reduce the risk of conditions like shin splints in this group of
athletes. If you have questions or are concerned about the female athlete triad, speak to your
health or medical professional.

Foot type and biomechanics

Other common factors thought to contribute to shin splints may include your foot type and
biomechanics, your running style and how your foot impacts the ground, footwear, muscle
strength and muscle flexibility. These are factors that your podiatrist will assess to help you
identify and address potential risk factors.

So what can be done?

Reducing the risk of shin splints involves a combination of preventive measures focusing on
proper training, footwear, and overall health. Podiatrists play a crucial role in assessing and
addressing the biomechanical factors contributing to shin splints. Through a comprehensive
evaluation, they can identify issues with your gait which may contribute to the condition and help
you manage your rehabilitation.

1. Gradual training progression. Avoid sudden increases in training intensity, duration, or
frequency. Gradually progress your training regimen to allow your body to adapt to the
demands of your physical activity. This approach helps prevent overuse injuries,
including shin splints.

2. Food for fuel and training for strength. Working with a dietitian, an exercise
physiologist and your GP, you can ensure your body has the fuel it requires to maintain
optimal health, energy for the activities you do each day, and enough left over to be
laying down bone minerals that you will need as you age.

3. Biomechanical assessments performed by your podiatrist as part of a comprehensive
assessment consider how your feet and legs function during running. During your
assessment, your podiatrist will be looking for the presence of factors that may lead to
increased load through particular muscles, or bones that could cause injury or pain,
including MTSS.

Once you notice pain associated with MTSS, you will need a comprehensive treatment plan to
address your own personal risk factors, and help your tibia to heal. Treatments may include the
following:

1. Rest – Due to the condition having an inflammatory component, any aggravation is
going to cause pain. MTSS is best managed by reducing training loads and introducing
periods of rest, particularly for younger athletes. This doesn’t mean lying in bed all day,
rest is relative to your current activity levels, and a plan for rest and return to sport
should be discussed with your podiatrist and coaching team.

2. Footwear – What you wear on your feet matters with shin pain. In some people, the
condition may be related to ankle flexibility (dorsiflexion) and therefore it is advised to
use running shoes with a mid to high heel drop (8mm+). Heel to toe drop is the
difference in height between heel and forefoot in an athletic shoe. It’s measured in
millimetres, going from 0 to 14mm in running shoes.

3. Custom Foot Orthotics – Orthotics may be beneficial in reducing the load around the
injured area and therefore reducing the pain. Orthotics are often used in conjunction with
footwear changes to have the best outcome.

4. Ankle Flexibility (Dorsiflexion) – Increasing the movement around the ankle joint can
help with shin pain. Ideally, you want to work on stretching both the gastrocnemius and
soleus (calf) muscles at the back of the leg. These stretches can be performed both
before and after activity.

5. Ice – Cryotherapy (ice) can be a very effective short-term solution to help alleviate pain.
10-15 minutes of ice applied directly to the area soon after sport can help.

6. Shockwave Therapy – also known as Extracorporeal Shock Wave Therapy (ESWT), is
a non-invasive treatment that uses high-energy shockwaves with the aim of stimulating
healing and reducing pain. Shockwave therapy is thought to work through several
mechanisms including stimulation of blood flow, tissue repair and cellular activity.

7. Imaging – If your pain continues or progresses despite following good advice, your
podiatrist may suggest imaging such as an MRI or bone scan to rule out the possibility of
a stress fracture.

Shin splints, or medial tibial stress syndrome, can be a painful and frustrating condition, but with
a good understanding and following preventive measures, individuals can reduce their risk of
developing this issue. Seeking guidance from a podiatrist, especially when experiencing
persistent pain, will involve a thorough assessment to develop a personalised treatment plan.
By addressing biomechanical factors and incorporating preventive strategies, individuals can
enjoy a more comfortable and injury-free active lifestyle.

References:
Kuwabara, A., Dyrek, P., Olson, E. M., & Kraus, E. (2021). Evidence-based management of
medial tibial stress syndrome in runners. Current Physical Medicine and Rehabilitation Reports,
1-9.
Mattock, J., Kirk, E., Mickle, K., & Steele, J. (2023). Do greater than 10% increases in external
training load contribute to medial tibial stress syndrome in long-distance runners? Journal of
Science and Medicine in Sport, 26, S108.
Rhim, H. C., Shin, J., Kang, J., Dyrek, P., Crockett, Z., Galido, P., … & Tenforde, A. S. (2024).
Use of extracorporeal shockwave therapies for athletes and physically active individuals: a
systematic review. British Journal of Sports Medicine.