Foto: iStock/Panuwat Dangsungnoen

Unfortunately, this happens far too often: pain on the front edge of the shinbone, which gets worse with each step. The only remedy is to stop running. What causes this pain response and what can I do about it?

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Pain in the lower leg can come unannounced at some point and doesn’t want to go away. The pain gradually increases, and no solution is in sight. The longer this condition persists, the worse the effects. But where does this pain come from? And what can I do about it?

Where exactly does it originate?

Periostitis on the edge of the shinbone, also called «shin splints», is mainly found in runners. The shinbone is the weight-bearing bone. Tension in the muscle insertions on the shinbone can trigger periostitis. The mechanism behind it equates to simple physics: if the muscle-tendon complex has too much tension, this stress is transferred to the bones. The increased pull of the muscle on the bone then irritates the site of connection between the tendon and bone (osteotendinous junction). In the graphic, this corresponds to the mineralised fibrocartilage zone, the periosteum. Unfortunately, the pain can also come from a fatigue fracture in the lower leg. It is important to differentiate and clarify this. Impact and vibrations make a fatigue fracture particularly painful. Hopping on one leg or landing with your heel firmly on the ground is much more painful with a fatigue fracture than with periostitis. Unfortunately, the distinctions between periostitis and a fatigue fracture are blurred. That's why early diagnosis and early action are important!

What are the differences in pain?

The anterior shinbone muscle (tibialis anterior), the posterior shinbone muscle (tibialis posterior) and the long toe flexors (flexor hallucis longus and flexor digitorum longus) are often concealed «spoilsports». The exact localisation of pain indicates the muscle that is affected. If the pain is somewhat higher on the outside of the lower leg, the front shinbone muscle is overloaded. If the pain is somewhat lower down on the inside, the posterior shinbone muscle and the toe flexors may be to blame. The foot position also allows conclusions to be drawn about the underlying cause: skew foot is more likely to point towards the posterior shinbone muscle, and claw toe to the toe flexors.

What's going wrong?

In the case of inflammation in the anterior shinbone muscle, it is primarily a weakened foot arch that overloads this muscle. The main task of the muscle is to lift the foot. But if it is also used to stabilise the foot, it will quickly reach its limits. When the foot is lifted more often, e.g., going uphill, the muscle is overloaded, resulting in irritation on the upper edge of the shinbone. However, if the posterior shinbone muscle is affected, the heel often skews inwards (hyperpronation) and the muscle here is overloaded by the constant tension. The same is true for the toe flexors; if the toes are in a claw position, the flexor muscle is overloaded. Both trigger pain in the lower third section of the leg on the inside of the shinbone.

What can I do about it?

Immediate action: stop jogging for a short period of time. You need to relieve the osteotendinous junction. Secondly: do structured foot muscle training. Here, it is important to know which muscles require functional training:

1. The front shinbone muscle should purely do the foot lifting work, it must not work as an arch stabiliser. Simply put, this needs to be practiced.
2. The hindfoot must be upright. The posterior shinbone muscle maintains this upright position. The heel thus becomes perpendicular again and doesn't skew inwards. More info.
3. The toes, above all the big toe, must no longer make a claw shape. The sole of the foot needs more length, more elasticity, and less tension. The functional unrolling of the toes requires a loose toe position. More info.

Suitable exercises

1. Exercise against claw toes

2. exercise against bent foot