Posterior tibial shin splints: understanding your leg pain and getting back to your activity

What are shin splints with suspected posterior tibial tendinopathy?

Tibia and posterior tibialis anatomy

These shin splints affect the postero-medial edge of the tibia, at the attachment area of the posterior tibialis muscle, which plays an essential role in supporting the arch of the foot. The pain is linked to repeated overload of this area, with possible associated involvement of the posterior tibial tendon when the pain extends toward the ankle and foot.

Why does this area become painful?

Posterior shin splints appear when the tibia and posterior tibialis are subjected to too much repeated load, particularly in people whose foot tends to collapse inward (excessive pronation). A too-rapid increase in running volume, unsuitable footwear, or weak foot stabilisers contribute to these shin splints.

Symptoms and diagnosis of posterior tibial shin splints

Typical pain and its triggers

Pain on the postero-medial edge of the tibia, triggered or worsened by running, prolonged walking, and sometimes palpable over several centimetres along the bone. Pain that extends toward the ankle and foot can indicate associated tendon involvement.

Differential diagnosis

Several types of leg pain can resemble these shin splints:

• A tibialis anterior muscle strain, more centred on the outer side of the tibia and linked to downhill running
• A tibial stress fracture, to consider in the case of very localised, intense, one-off pain despite rest

Causes and risk factors

These shin splints develop when the tibia and posterior tibialis are subjected to too much repeated load.

Risk factors

• Excessive foot pronation (the arch collapsing inward)
• A too-rapid increase in running volume
• Unsuitable footwear
• Weak foot stabilisers

Which sports contribute to posterior tibial shin splints?

All sports with repeated ground impact, particularly for runners with pronation, are involved:

• Running, particularly for runners with marked pronation
• Football and running-jumping sports
• Hiking and trail running
• Dance
• Jobs involving prolonged standing and intensive walking

Treating posterior tibial shin splints in rehab with a sports physio

The goal of treatment is to temporarily reduce load on the tibia while progressively strengthening the posterior tibialis and the arch stabilisers.

1. 1Reducing pain and managing load
2. 2Ankle and foot mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Correcting weight-bearing and stride
7. 7Progressive strengthening of the running chain
8. 8Strengthening under sport-specific load
9. 9Progressive return to running
10. 10Return to competition

“It’s not that the tibia is fragile, it’s that the load needs to be better dosed and progressive.”

Strengthening and arch support, the cornerstones of treatment

Strengthening the posterior tibialis and the foot’s intrinsic muscles, combined with progressively managing running volume, durably reduces strain on the tibia and restores better arch support.

In brief

• Strengthening the posterior tibialis
• Strengthening the arch stabilisers
• Progressively managing running volume
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary. It’s better to temporarily reduce the running volume and intensity that clearly reproduce the pain, while starting strengthening as soon as possible.

When should you see a specialist for posterior tibial shin splints?

If pain persists for more than four to six weeks despite adapting your activities, or if you notice your arch progressively collapsing, a medical opinion is recommended.

Expected progression of posterior tibial shin splints

A structured programme generally gives a clear improvement within a few weeks, with a full return to sport after several weeks of progressive load management and strengthening.

Preventing recurrence

Several measures help limit the risk of recurrence once pain has resolved:

• Progress cautiously in your running volume and intensity
• Choose suitable footwear, with arch support if needed
• Keep up regular strengthening of the posterior tibialis and foot stabilisers
• Don’t ignore discomfort that reappears when returning to higher volume

The HOPP care programmes to treat your posterior tibial shin splints and get back to sport

These shin splints require progressive load management and targeted strengthening of the posterior tibialis. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your leg is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

Start my programme →

F.A.Q