Delving into Lower Extremity Complaints: Case Studies & Solutions: WIR 26
Week in Review: Cross-Country Runners, Medial Shin Pain, and Ankle Sprains
In this week’s Week in Review podcast, Dr. Beau Beard, Dr. Alex Coleman, and Seth Graham dive deep into two challenging cases from their clinic involving cross-country runners. Both athletes presented with lower extremity complaints—one with repeated medial shin pain, and the other with lingering medial ankle pain following an inversion ankle sprain. These cases provided a platform to discuss the nuanced process of differential diagnosis, movement retraining, and how emerging research, such as the recent case series on foot strike retraining for patients with patellofemoral chondral defects, can influence clinical decision-making.
Case One: Repeated Medial Shin Pain
The first athlete was a high school cross-country runner who presented with recurring medial shin pain. For clinicians, shin pain is a common but deceptively complex complaint. While “shin splints” (medial tibial stress syndrome) is the term most athletes and coaches are familiar with, this label often oversimplifies a spectrum of possible issues ranging from periostitis to tibial stress reactions or compartment syndromes.
In the podcast, the FARM team outlines their approach to ruling out more concerning pathology such as stress fractures. They emphasize the importance of not jumping to conclusions, instead carefully layering together the athlete’s history, palpatory findings, imaging when indicated, and functional movement assessment.
Biomechanical overload often plays a central role in shin pain, particularly in runners with high training volumes. Contributing factors can include abrupt increases in mileage, poor footwear choices, or running form that amplifies impact forces. The team discusses how subtle changes—such as excessive pronation, increased tibial rotation, or limited ankle dorsiflexion—can be the hidden drivers of shin pain.
The treatment strategy involved calming the irritated tissue through manual therapy, load modification, and gradual reintroduction of running. But the broader conversation centered on empowering the athlete with movement strategies and recovery tools that would reduce recurrence and support long-term performance.
Case Two: Medial Ankle Pain Post-Inversion Sprain
The second case centered on a female cross-country runner recovering from a recent inversion ankle sprain. Though the initial swelling and instability had resolved, she continued to experience nagging medial ankle pain, particularly during runs.
The FARM team highlights how ankle sprains are often underestimated in their long-term impact. While many athletes return to sport quickly, unresolved deficits in proprioception, mobility, or load distribution can set the stage for chronic pain or recurrent sprains. In this runner’s case, the pain pattern raised red flags for possible posterior tibialis tendon involvement, spring ligament stress, or even subtle osteochondral irritation within the talus.
The discussion underscores the importance of a comprehensive ankle exam after inversion injuries. Rather than treating lingering symptoms as “just part of the healing process,” the clinicians dug into gait mechanics, load transfer through the medial foot, and stability in single-leg tasks.
Treatment centered around restoring ankle and foot function—addressing both local tissue health and the broader kinetic chain. That meant strengthening intrinsic foot muscles, retraining balance and proprioception, and gradually challenging the ankle under running-specific conditions.
Connecting the Cases: The Role of Foot Strike Retraining
An interesting thread between both cases is the potential role of foot strike mechanics in either contributing to or alleviating lower extremity pain. This led the conversation into a discussion of the recent research article: “Foot Strike Run Retraining for Patients With Patellofemoral Chondral Defects: A Case Series” (PubMed ID: 37930763).
This case series investigated how altering foot strike patterns could offload patellofemoral joint stress in patients with chondral defects. By transitioning some runners toward a forefoot or midfoot strike pattern, researchers noted improvements in symptoms and function, suggesting that gait retraining can be a powerful clinical tool.
For the FARM clinicians, this study reinforces the idea that running injuries are rarely isolated to one joint or tissue. Instead, they are the result of complex load-distribution patterns. In the case of the runner with shin pain, modifying foot strike could potentially reduce tibial stress by shifting load absorption more proximally or distally. For the ankle sprain patient, careful retraining might improve stability and decrease repetitive strain on healing tissues.
Of course, the podcast team is quick to emphasize that foot strike retraining is not a universal fix. Changing running mechanics requires careful progression, coaching, and monitoring to avoid simply trading one problem for another. But in the right context, supported by evidence, it can be a game-changing intervention.
Broader Lessons for Athletes and Clinicians
What makes this Week in Review episode particularly valuable is how it illustrates the FARM’s core philosophy: using clinical reasoning and patient-centered care to find solutions rather than quick fixes. A few key takeaways stand out:
Assessment is Everything – Both cases highlight the importance of listening to the athlete’s story, performing thorough exams, and considering the whole kinetic chain rather than treating symptoms in isolation.
Injuries Are Multifactorial – Shin pain and ankle sprains aren’t just “bad luck.” They often reflect training errors, mechanical inefficiencies, or incomplete rehab.
Movement is Medicine – Whether through strengthening, balance training, or gait retraining, empowering athletes with movement strategies is more effective than passive care alone.
Evidence Should Guide Practice – Incorporating emerging research, like the foot strike case series, ensures that clinical interventions are informed, not dogmatic.
Long-Term Resilience Matters – The ultimate goal is not just returning athletes to their next race, but building durability so they can enjoy years of healthy running.
Conclusion
This week’s Week in Review provides a fascinating look into the challenges and solutions for common yet complex running injuries. By walking through two real-world cases, the FARM team highlights the importance of clinical reasoning, the value of integrating research into practice, and the central role of empowering athletes to take ownership of their health.
The conversation is a reminder that running injuries are never just about “where it hurts.” They are about how the body moves, how it adapts, and how small changes in training, recovery, or mechanics can create lasting impact.
For cross-country runners, coaches, and clinicians alike, this episode offers both practical insights and a bigger-picture philosophy: when it comes to injury prevention and performance, details matter—and the path to resilience runs through thoughtful, functional care.
Foot Strike Run Retraining for Patients With Patellofemoral Chondral Defects: A Case Series https://pubmed.ncbi.nlm.nih.gov/37930763/
