Posterior shin splints are one of the most common running injuries we treat at ModPod Podiatry. The pain sits along the inner edge of your shinbone, right where the posterior tibialis muscle attaches. It feels different from the front-of-shin ache you get with anterior shin splints — and it needs a different approach to treat.
This guide covers what posterior shin splints are, why they happen, and how to get rid of them.
What Are Posterior Shin Splints?
Posterior shin splints — also called posterior medial shin splints — involve irritation and inflammation where the posterior tibialis muscle connects to the inner border of your tibia. The posterior tibialis is a deep calf muscle that supports your arch and controls how your foot rolls inward when you walk or run.
When this muscle is overloaded, the tissue where it anchors to the bone becomes inflamed. This is known as medial tibial stress syndrome (MTSS). Pain runs along the lower two-thirds of the inner shin, and it can range from a dull ache during activity to sharp pain with every step.
Posterior shin splints differ from anterior shin splints in location and mechanism. Anterior shin splints affect the muscles at the front of the shin (tibialis anterior). Posterior shin splints target the inside and back of the shin, and they are linked to how your foot and ankle absorb impact.
Not sure which type you have? Take our shin splint quiz for a quick guide.
Causes
Several factors contribute to posterior tibialis shin splints. Most cases involve a combination of biomechanical issues and training errors.
Overpronation. When your foot rolls inward too far during each stride, the posterior tibialis works overtime to stabilise your arch. This repeated strain is the leading cause of posterior medial shin splints.
Flat feet. Low or collapsed arches place extra load on the posterior tibialis with every step — even during walking.
Sudden training increases. Adding too much distance, speed, or hill work too fast overwhelms the muscle before it can adapt.
Worn footwear. Old or unsupportive shoes fail to control pronation or cushion impact. Runners should replace shoes every 600–800 km.
Hard surfaces. Training on concrete or asphalt increases the ground reaction force that travels up your shin.
Weak calf and hip muscles. Poor calf strength means the posterior tibialis picks up the slack. Weak hips allow the knee to collapse inward, which drives more pronation at the foot.
Symptoms
Posterior shin splints produce a recognisable pattern of symptoms:
- Pain along the inner, lower shin. The tenderness follows the inner border of the tibia, usually in the lower half.
- Pain that worsens during push-off. The posterior tibialis fires hardest as your foot pushes off the ground, so this phase of your stride hurts most.
- Tenderness along the posterior tibialis tendon. Pressing along the inner shin edge or just behind the ankle bone reproduces the pain.
- Morning stiffness. The area feels tight and sore when you first get out of bed, then eases once you move around.
- Pain that builds during exercise. Early on, discomfort fades after a warm-up. As the condition progresses, pain persists throughout the session and lingers afterward.
If pain continues at rest or becomes a focused, pinpoint ache, see a podiatrist. This could signal a tibial stress fracture rather than shin splints.
Treatment
Most cases of posterior shin splints respond well to conservative treatment. Here is what works.
Relative rest. Cut back on high-impact activity. Switch to swimming, cycling, or pool running to maintain fitness while the tissue heals.
Ice. Apply ice along the inner shin for 15–20 minutes after activity. This helps manage inflammation and pain.
Orthotics. Custom orthotic insoles control overpronation and reduce the load on the posterior tibialis. For patients in Sydney CBD, we also offer custom orthotics at our Hunter Street clinic. Orthotics are one of the most effective long-term solutions for recurring posterior shin splints.
Footwear changes. A structured, supportive running shoe matched to your foot type makes a measurable difference. Our podiatrists use digital video analysis to assess your gait and recommend the right shoe.
Calf and tibialis strengthening. Eccentric calf raises, single-leg heel raises, and tibialis posterior exercises build the muscle’s capacity to handle load. Strengthening the hips and glutes also helps control leg alignment.
Taping. Shin splint taping supports the arch and takes tension off the posterior tibialis. It works well as a short-term measure alongside other treatments.
Graduated return to activity. Follow a structured return-to-running plan. Increase weekly distance by no more than 10% to avoid re-injury.
For more treatment options, read our guide on 5 effective treatments for shin splints.
When to See a Podiatrist
See a podiatrist if:
- Pain persists for more than two weeks despite rest and ice
- Symptoms return each time you increase training
- You feel a sharp, localised pain in one spot on the tibia — this may indicate a stress fracture
- Pain occurs at rest or during normal walking
Early assessment prevents a simple case of posterior shin splints from becoming a stress fracture. A podiatrist can perform a biomechanical assessment, check your gait with digital video analysis, and build a treatment plan that addresses the root cause — not just the symptoms.
Get Help for Posterior Shin Splints in Sydney
ModPod Podiatry treats posterior shin splints at five clinics across Sydney:
- CBD — Suite 506, 66 Hunter Street, Sydney NSW 2000
- Mosman — 2/59 Harbour St, Mosman
- Dee Why — Suite 4103/834 Pittwater Road, Dee Why NSW 2099
- Rose Bay — 668a New South Head Road, Rose Bay NSW 2029
- North Ryde — 136 Coxs Road, North Ryde NSW 2113
Our sports podiatrists identify the cause, treat the pain, and help you return to training without setbacks. We use digital video analysis, custom orthotics, and structured rehab plans to get results.
Visit our shin splints treatment page for a complete overview of how we diagnose and treat all types of shin splints.
Book online or call (02) 9960 3981 to make an appointment.
