Do you have nagging pain in the front of your shin or ankle? Is it dull and aches but can occasionally be sharp? Do you have more pain when going down stairs or walking or running on hills? You may have anterior tibial tendonitis.

Most cases of tendinitis are due to repetitive stress, either from excessive or abnormal activity on a normal tendon, or from normal stresses on an already injured or torn tendon. Inflammation occurs along the tendon sheath and causes swelling. Symptoms usually are described as a dull aching pain that is aggravated by activity such as walking, running or going down stairs. In addition to palpable tenderness, thickness of the tendon may be noted, and there can be creaking also known as crepitus during up and down motion of the ankle.

A tight calf muscle and hamstring is frequently seen in athletes with anterior tibialis tendinitis. The biomechanical stress develops when the tight Achilles tendon limits ankle motion. This causes the foot to heel strike with a great deal of force. The muscles in the lower leg try to slow this heavy foot strike and control it, which leads to overuse muscle fatigue and, eventually, muscle inflammation and pain.

The anterior tibialis muscle in the front of the shin can become inflamed and cause a classic “shin splint” pain. This muscle attaches to the foot and flexes the foot upward or back toward the shin; as long as the foot is in normal alignment with the leg, the muscle functions efficiently and pain-free. However, when the foot is pronated (rolling in at the ankle and foot level) the anterior tibialis muscle twists abnormally. This twisting can cause tiny tears in the muscle producing inflammation and pain.

If we recognize anterior tibialis tendonitis as a biomechanical problem, it makes sense that a biomechanical solution is in order. Rest, ice, anti-inflammatories and physical therapy may treat the pain and symptoms of inflammation; but if the biomechanical imbalance isn't addressed, recurrence is highly likely.

The structures and the functioning of the foot, ankle and knee are all exposed to greater stresses during running. The most important biomechanical actions during running are the timing and amount of pronation at the foot and ankle. If there is too much pronation or if the foot stays in pronation too long (prolonged pronation), the biomechanics of gait are altered and running is less efficient.

Excessive pronation also increases the internal rotation of the tibia, placing additional stress on the knee.

When running is a dominant component of the recreational choices of an individual, the natural biomechanics must be able to sustain these higher forces. Studies have demonstrated a significant decrease in tibial internal rotation4 and pronation velocity when using orthotics, which will help to prevent injuries to this area.

After the symptoms have dissipated with therapy, modalities to decrease lower leg stressors should be reviewed. These include better-fitting stability running shoes, changing running surfaces, and better warm-ups and cool-downs.

Custom functional orthotics to stabilize flexible foot types are necessary for many athletes to support the arches and reduce pronation, as well as to decrease the stress of heel strike on the foot and leg.

If you are experiencing classic “shin splints” or a nagging pain in the front of your ankle, you may have anterior tibial tendonitis. The faster you treat this injury, the less nagging it becomes. Contact us for evaluation and gait analysis. Remember that rest alone often does not lead to long-term successful treatment of anterior tibial tendon injuries.