Bilateral Anterior Tibial Pain: Referred Pain From Osteoarthritis of the Hip. A Case Report

STUDY DESIGN: Case report. BACKGROUND: Hip pathologies can cause referred pain to the buttock, groin, thigh, lower back, or knee. However, it is less commonly recognized that the pain can manifest below the knee. Consequently, hip joint pathologies are rarely included in the differential diagnosis of lower leg pain. CASE PRESENTATION: An active 51-year-old female presented with an 18-month history of bilateral posteromedial lower leg pain. Pain in the buttock, groin, thigh, lower back, or knee was absent. She was initially diagnosed and treated for medial tibial stress syndrome, but her symptoms progressively worsened. Re-evaluation revealed restricted bilateral hip range of motion, and the diagnosis of hip osteoarthritis was confirmed on x-ray. OUTCOME AND FOLLOW-UP: Physical therapy initially provided partial relief, but symptoms worsened over time. A local anesthetic injection into the hip joint relieved her ipsilateral lower leg pain. Eventually, bilateral total hip replacement resulted in complete alleviation of her shin pain within 21 days. DISCUSSION: This case demonstrates an 18-month delay before a conclusive diagnosis was made. We suggest including a hip joint examination in the evaluation of patients with lower limb complaints, as hip pathology may present as referred pain to the lower leg. JOSPT Cases 2025;5(4):252-257. Epub 15 September 2025. doi:10.2519/josptcases.2025.0123