Foot Health News

MEDIAL SHIN PAIN GUIDE

Medial shin pain: what causes it and what can you do about it?

Pain along the inside of the shin is common in runners, walkers, athletes and people who have recently increased their activity. Understanding why it happens is the first step towards managing it safely and rebuilding lower-leg capacity.

Close-up of lower legs representing medial shin pain
Common symptoms What causes it When to seek help What you can do Online exercise program

What is medial shin pain?

Pain along the inside of the shin is often referred to as shin splints. The clinical term commonly used is medial tibial stress syndrome (MTSS). It is usually felt along the lower portion of the inside border of the tibia, or shin bone.

Medial shin pain should not be treated as one simple problem with one universal fix. There is often a number of factors involved. It is important to understand MTSS can resemble other (more serious) conditions, including stress fracture, so the location and behaviour of the pain is key.

COMMON SIGNS

  • A dull or aching pain during or after running, jumping or brisk walking
  • Tenderness spread across a longer area along the inside of the shin
  • Discomfort that improves when activity is reduced but returns when training resumes
  • Mild swelling in some cases

MTSS is generally diagnosed from a person's history and a physical examination. A commonly used clinical feature is recognisable tenderness extending across 5 cm or more along the posteromedial border of the tibia. [1]

What causes medial shin pain?

The easiest way to understand medial shin pain to know it is as a load-versus-capacity problem. Running and jumping repeatedly load the tibia and the muscles around it. Bone and soft tissue can and will adapt to this stress. However when load is increased, due to rapid increase in training volume or reduced recovery time between sessions, pain can present.

Training load

Too much, too soon

A rapid increase in running, walking, jumping, hill and/or speed work may exceed the lower leg's current capacity.

Recovery

Not enough time to adapt

Training frequently without adequate recovery may allow irritation to build from one session to the next.

Change

A rapid change in demand

Returning to previous sport/activity after time away or injury is a common cause of increased lower-leg loading.

A MULTIFACTORIAL CONDITION

Research suggests that MTSS is not caused by one muscle, one type of foot or one movement pattern. Previous running injury, greater navicular drop, higher body weight and certain differences in hip or ankle movement have been associated with risk. These are risk factors, not guarantees, and they do not mean that one particular foot posture is “bad.” [2] [3]

Is it shin splints or a stress fracture?

Not all pain along the shin is MTSS. A tibial stress fracture, chronic exertional compartment syndrome, nerve irritation and other conditions can produce similar symptoms.

MTSS more often causes tenderness across a broader section of the inner shin. A stress fracture is more likely to produce a smaller, clearly defined area of bone tenderness. MRI may be used when a clinician suspects a bone stress injury or needs to rule out another condition. [4]

SEEK PROFESSIONAL ADVICE IF

  • The pain is severe, worsening or not improving
  • You cannot walk or bear weight comfortably
  • The pain is focused on one small point of the bone
  • You have pain at rest or at night
  • There is significant swelling, redness, numbness or weakness
  • Symptoms repeatedly return when you resume activity

A Podiatrist, physiotherapist, sports medicine professional or GP can review your symptoms and decide whether imaging is needed. [5]

What should you do when medial shin pain starts?

Rehabilitation of MTSS is rarely about finding one perfect exercise. An effective approach should incorporate appropriate load management, progressive exercise (strength and muscular release) and a gradual re-introduction of impact based activities.

1

Reduce the aggravating load

Temporarily reduce running, jumping, hills or other movements that reproduce your symptoms. This does not always mean stopping all movement.

2

Build capacity gradually

Rehabilitation may include progressive calf strengthening, foot control, balance, mobility and hip strength work based on individual needs.

3

Return to impact progressively

Once everyday walking and your starting exercises are comfortable, impact activity can be reintroduced in manageable stages.

4

Review the whole picture

Training volume, adequate recovery, sleep, footwear, movement capacity and previous injuries can all influence lower-leg tolerance.

WHAT THE RESEARCH TELLS US

A 2025 randomised study found that adding lower-leg exercises to multimodal care improved foot-posture measures and quality of life, but did not produce a significant additional reduction in pain or MTSS severity. Exercise can support a broader plan, but it is not an instant cure. [6]

Another randomised trial found that adding calf exercises or compression stockings to a graded running program did not shorten recovery compared with graded running alone, highlighting that no single addition works for everyone. [7]

Can medial shin pain be prevented?

No strategy can prevent every case, but the following habits may help reduce unnecessary spikes in lower-leg load:

  • Increase running, walking and jumping activities gradually
  • Avoid changing distance, speed, intensity and training frequency all at once. Instead look to only progress one at a time
  • Allow adequate recovery between demanding sessions
  • Maintain muscular strength and control through the feet, calves and hips
  • Replace worn out or uncomfortable footwear and transition gradually when changing shoe type
  • Respond early when soreness continues to build instead of repeatedly pushing through it

A 2025 systematic review found evidence supporting neuromuscular training for MTSS prevention. Insoles designed for people with overpronation may also help some populations, but they are not automatically needed by everyone and are best selected following individual assessment. [8]

Medial Shin Pain Program

The Rehab Mechanics Medial Shin Pain Program provides a structured approach to foot, ankle and lower-leg mobility, strength and control. It is designed to help you build capacity progressively and move with greater confidence.

  • Build lower-leg capacity with progressive exercise
  • Improve mobility and control through the feet and ankles
  • Follow a clear structure rather than guessing which exercises to perform

If your pain is severe, focal, present at rest or has not been properly assessed, speak with a qualified health professional before beginning the program.

View the Medial Shin Pain Program

References

  1. Winters, M. (2020). The diagnosis and management of medial tibial stress syndrome: An evidence update. Unfallchirurg, 123(Suppl 1), 15–19. View reference
  2. Reinking, M. F., Austin, T. M., Richter, R. R., & Krieger, M. M. (2017). Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health, 9(3), 252–261. View reference
  3. Becker, J., Nakajima, M., & Wu, W. F. W. (2018). Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Medicine & Science in Sports & Exercise, 50(10), 2092–2100. View reference
  4. Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. (2019). Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and Sportsmedicine, 47(1), 47–59. View reference
  5. Healthdirect Australia. Shin splints: symptoms, causes, treatment and diagnosis. View reference
  6. Naderi, A., Fallah Mohammadi, M., Heidaralizadeh, A., & Moen, M. H. (2025). Effects of Integrating Lower-Leg Exercises Into a Multimodal Therapeutic Approach on Medial Tibial Stress Syndrome Management Among Recreational Runners. Orthopaedic Journal of Sports Medicine, 13(2). View reference
  7. Moen, M. H., Holtslag, L., Bakker, E., et al. (2012). The treatment of medial tibial stress syndrome in athletes: a randomized clinical trial. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, 4, 12. View reference
  8. Marques, T. B. T., Rangel, R. P. S., Martins, L. V., & Vidal, A. P. C. (2025). Preventive interventions for medial tibial stress syndrome: Systematic review and meta-analysis. Gait & Posture, 122, 92–98. View reference
  9. Saad, M. A., Jamal, J. M., Aldhafiri, A. T., & Alkandari, S. A. (2025). Medial Tibial Stress Syndrome: A Scoping Review of Epidemiology, Biomechanics, and Risk Factors. Cureus, 17(3), e81463. View reference

This article provides general education only and is not a diagnosis or a substitute for individual medical advice.