Why Some Forefoot Runners Have Shin Tendon Pain

Shin tendon pain, especially on the inner part of the lower leg, is extremely common in joggers who heel strike. One of the easiest ways to prevent running related-shin problems is with forefoot running. However, many newly transitioned forefoot runners still struggle with medial shin pain. In this case, a narrow step width or a crossover running gait is the culprit.

How Forefoot Runners Can Prevent Shin Tendon Pain

Why Some Forefoot Runners Have Shin Tendon Pain

A study by Meardon and Derrick (2014) investigated the effects of step width manipulation on tibial strain in runners (step width is the distance between the feet during successive foot strikes). The runners  were given a verbal cue to run with a narrower or wider step width, both of which were to be 5% more than their preferred step width.

The result: running step width influences medial tibia tension at touchdown whereby a wider step width reduces medial compression and tissue loads as compared with crossover running. Interestingly, a wider step width also reduced normal stress loads and reduced lower anterior tension as well as posterior and medial tibial compression.

By comparison, a smaller running step width has been linked to greater pronation, hip adduction and knee internal rotation, which increases the medial-lateral ground reaction force, torsional loading and tibia strain — all are implicated in tibial stress fracture progression in runners.

The trick to avoiding these adverse reactions when forefoot running is by making the new effort of opening up your step width, making sure your feet land farther apart. And remember, a narrow running step width is not the only culprit in chronic shin pain. Cushioned running shoes, for example, enable a runner to land hard on the ground, causing more widespread impact to the leg. Barefoot running shoes promote ‘lighter’ interactions with the ground, not to mention running barefoot is even better at reducing musculoskeletal loading.

Nonetheless, a great way a forefoot runner can widen their step width is to run over top of the line on the side of the road, making sure your feet land on either side, not on or near the line, but rather your running step width should equal the width of your hip. Hope this helps!

Be sure to check out a more detailed depiction of a forefoot strike, just to make sure you are landing correctly.

More From Run Forefoot:

How Cushioned Running Shoes Alter Natural Foot Strike

7 Top Running Shoe Brands for Forefoot Runners

7 Benefits of Running in Minimalist Shoes

How Ditching Heel Strike Helped Meb Win Boston

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P.S. The Run Forefoot Facebook Page is a great place to ask questions related to forefoot running mechanics, injury, barefoot running and footwear. I’m always happy to help!


Meardon SA and Derrick TR. Effect of step width manipulation on tibial stress during running. J Biomech, 2014;47, 2738-2744.

Brindle, R.A., Milner, C.E., Zhang, S., Fitzhugh, E.C., 2013. Changing step width alters lower extremity biomechanics during running. Gait Posture 39, 124–128.

Pohl, M.B., Messenger, N., Buckley, J.G., 2006. Changes in foot and lower limb coupling due to systematic variations in step width. Clin. Biomech. 21, 175–183

McClay, I.S., 1995. The use of gait analysis to enhance the understanding of running injuries. Mosby, St. Louis MO, pp. 395–411.

Bretta Riches

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!