By Simon Moloney (Podiatrist & Clinic Partner), Bachelor of Podiatry
It’s a story we hear all the time: you’re four weeks into a consistent training block, you’re feeling fitter than ever, you’re seeing your splits improving and then it creeps up suddenly – the dull nagging ache along the inside of your shin. Maybe it initially settles but returns quickly on your next run, this time a sharper, throbbing intensity.
Naturally as a runner, you might try to negotiate with yourself: “It’s just tight muscles, I’ll take a day off, stretch and foam roll it and I will be able to finish off my Sunday Long run later in the week.”
At My FootDr, our podiatrists see these cases every week, and the unfortunate truth is, mistaking the early signs of a tibial stress fracture for shin splints can be the difference between a two-week deload and a three-month sidelining.
In this guide we’re going to dive into the specific mechanics behind a runner’s shin pain, how to know if your injury is serious, and the steps you can take to get back running injury free.
What are shin splints?
Within the running community, shin splints is an umbrella term for a range of specific injuries. Clinically, we call it Medial Tibial Stress Syndrome (MTSS). This condition occurs when the muscles, tendons and lining of your shin bone (tibia) become overloaded and inflamed.
This can occur following an increase in load which is often driven by a change in mileage, a change in footwear or adding in other high impact activities outside of running. With MTSS, runners might notice:
- Warms up with running. Pain along the inside of your shin within the first kilometre of a run that can fade as blood flow increases and tissue loosens. While you might finish your run feeling strong, it can return with a vengeance the next morning.
- A dull ache. The pain is diffuse along the broader shin bone. If you were asked to point to your pain, you would likely rub the entire inside part of your lower leg.
- Post-run stiffness. Your shins may feel heavy and tender to touch, especially in your first steps out of bed.
What is a stress fracture?
A stress fracture is when a genuine crack forms within the tibia due to repetitive stress.
Running of any kind will always cause micro-damage, however, in a healthy training cycle the body will be able to repair the bone at the same rate and make it stronger. When the rate of damage exceeds the rate of repair, the bone structure begins to fail and result in a bone stress injury. This starts as what is called a stress reaction (bone bruising) and ends as a fracture.
How a runner experiences a stress fracture:
- Focal pain. Point-specific, sharp pain on your shin (location can vary).
- Progressively worse with running. Unlike shin splints, stress fractures do not warm up. While it may feel okay for a few minutes, pain will intensify throughout a run until you are forced to limp or stop.
- Night aches. You might feel a deep ache in your shin throbbing while trying to sleep or with general daily activities. This is a classic feature of a stress fracture.
Single leg hop test
Before you head out for your next run you can try this test to give you a better idea of what might be causing your pain:
- Stand on your affected leg.
- Hop on the spot 3-5 times in a row
- It is likely shin splints if you can do this, though it feels tight or uncomfortable
- It is more likely a stress fracture if you can’t land a hop without a sharp, stabbing pain.
Why do they happen?
Shin splints and stress fractures both fall under overuse injuries and are always multi-factorial in nature. The key things to consider area:
- Training error. Too much, too soon, with too little rest. If you have recently added in hill repeats or intervals and you’ve increased your weekly volume by 10%, this can be a perfect combination to lead to bone stress.
- Footwear. The wrong type or worn-out running shoes can contribute to loading forces in the tibia.
- Biomechanics. Flat feet, high arches, overstriding and excessive foot pronation can all increase stress at the tibia.
- Deficits. Weakness in calf muscles.
How MyFootDr can help
If you come into one of our clinics, our goal isn’t just to tell you to stop running, but instead to find the safest path back to pain-free running. Every treatment plan will be individualised but can often include:
- Early diagnosis. Your podiatrist will perform a comprehensive lower limb exam and can often make a diagnosis during your appointment. If required, they can also refer directly for x-rays or an MRI.
- Video gait analysis and running assessments. How your hips, knees and feet move while you walk or run may contribute to your shin pain. Strike pattern and increased pronation may both increase stress on your shin and be identified during your assessment.
- Footwear assessment. The right running shoe is key. Our podiatrists can help assess whether your current footwear are appropriate, require replacement or guide you in choosing the right shoe that suits your biomechanics.
- Home exercise program. Foot, ankle and calf strength are vital for treating and preventing shin splints and bone stress injuries. We can help guide you with a tailored program of the right types of exercises to compliment your running program.
- Custom orthotics. In many cases, runners can benefit from custom orthotics that are designed to reduce stress on the shin by changing foot and ankle alignment and altering loading forces.
- Moon boot (CAM walker) fittings. If your shin pain is indeed confirmed as a stress fracture, offloading is essential and moon boots can do just that while keeping you on your feet. Depending on your location our podiatrist can fit you with your moon boot during your appointment.
When to see a podiatrist
If you are experiencing focal shin pain, pain that doesn’t improve after warming up or resting, or if you’re struggling to walk without pain, it is better to be safe and seek help from a podiatrist.
We get it. Whether you’re training towards a new PR, on the countdown to a bucket-list marathon or if running is just your therapy, having some time off is the last thing you want to hear.
The good news is that with the right treatment plan, you can often continue to run. Or if you do indeed have a bone stress injury, catching this early can mean the difference between a two-week break and a 3-month sidelining.
Don’t leave your shin pain up to chance book with one of our podiatrists today.