Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Are Shin Splints?

Shin splints is the common term for medial tibial stress syndrome (MTSS) — diffuse pain along the inner border of the tibia (shinbone) in the lower two-thirds of the leg, caused by repetitive loading that exceeds the bone’s and periosteum’s (bone lining’s) ability to adapt. MTSS represents a continuum of bony stress injury, ranging from mild periosteal inflammation to frank tibial stress fracture at the severe end. Understanding where on this continuum a patient falls is the critical first step in appropriate management — the treatment and return-to-running timeline for periosteal irritation differs dramatically from that for a cortical stress fracture.

MTSS is one of the most common running injuries, accounting for 13–17% of all running-related injuries and up to 35% of injuries in military recruits during training. Women have a modestly higher incidence than men. The condition affects both experienced runners during periods of increased training load and beginning runners who escalate volume too rapidly.

Distinguishing MTSS from Tibial Stress Fracture

Both MTSS and tibial stress fracture cause medial tibial pain with running, but the distinction is critically important. MTSS typically produces pain over a broad area (often 5 cm or more) along the posteromedial tibial border that comes on after a run, improves with warm-up, and is not reproduced by direct focal pressure on a specific point. Tibial stress fracture characteristically causes pain earlier in the run (and eventually at rest), does not improve with warm-up, and — critically — has a focal point of exquisite tenderness on direct palpation of the tibial cortex. The “tuning fork test” (applying a vibrating 128 Hz tuning fork to the tibia) and the “hop test” (single-leg hopping on the affected side) may reproduce stress fracture pain. MRI is the gold standard for differentiating MTSS from stress fracture and grading stress reaction severity — plain X-rays may be negative even with a fracture.

Risk Factors and Biomechanical Contributors

Female sex, low bone density (particularly in athletes with the female athlete triad — energy deficiency, menstrual dysfunction, and low bone density), rapid training escalation, running on hard surfaces, and overpronation (excessive inward rolling of the foot with each step) are established risk factors. Excessive hip adduction during running — the hip dropping inward with each footstrike — increases tibial bending stress and is a biomechanical risk factor increasingly recognized as modifiable through gait retraining. Calf weakness, reduced ankle dorsiflexion range of motion, and excessive tibial internal rotation contribute in some runners. Inadequate caloric intake and Vitamin D deficiency impair the bone remodeling that enables adaptation to training loads.

Treatment: Load Management and Rehabilitation

The cornerstone of MTSS treatment is load modification — reducing the magnitude and frequency of the bone-loading activities that provoked the stress reaction. This does not necessarily mean complete running cessation; it means reducing to a level where the bone can adapt without progressively accumulating damage. Cross-training with non-impact activities (swimming, cycling, aqua jogging, elliptical) maintains aerobic fitness during the load reduction period. Pain should guide return to running — activities that produce pain during or after exercise indicate excessive load. A graded return-to-run protocol progressing from walk-run intervals to continuous running over 4–8 weeks (depending on severity) is the standard rehabilitation approach.

Footwear assessment and custom orthotic prescription addressing overpronation contribute meaningfully to treatment and prevention. Calf strengthening (single-leg calf raises, particularly with a slight knee bend to target the soleus) reduces tibial loading through improved energy absorption. Gait retraining to reduce hip drop (Trendelenburg) and tibial impact forces is appropriate for runners with identifiable gait faults. Calcium and Vitamin D sufficiency should be confirmed and supplemented if deficient. Tibial stress fracture requires complete non-weight bearing for 6–8 weeks, sometimes with crutches, before graduated return to activity.

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Shin Splints Treatment in Michigan

Medial tibial stress syndrome (shin splints) is one of the most common running injuries, often linked to overpronation and training errors. At Balance Foot & Ankle, Dr. Tom Biernacki provides biomechanical analysis and treatment to resolve shin splints — serving Howell and Bloomfield Hills, MI.

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Clinical References

1. Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Medial tibial stress syndrome: a critical review. Sports Med. 2009;39(7):523-546.
2. Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW. Treatment of medial tibial stress syndrome: a systematic review. Sports Med. 2013;43(12):1315-1333.
3. Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013;4:229-241.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.