Nutrient foramina are normal anatomic structures that typically appear linear on radiographs and can therefore mimic fractures. When seen en face, they may appear rounded or ovoid. The interpreting radiologist must be aware of the typical location and appearance of the various nutrient foramina to avoid misdiagnosing them as osseous pathology, such as fractures or lytic bone lesions. We present a case of a rare anterior tibial nutrient foramen in an adolescent patient with anterior shin pain. We also review the literature on location of tibial nutrient foramina, and discuss the potential for misdiagnosing these foramina as a pathologic finding.