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Medial tibial stress syndrome (MTSS) is a common overuse injury in those who do a lot of running. It is an injury that occurs to the tibia or shin bone. In the past this used to be called ‘shin splints’ which is named after a similar condition that occurs in race horses. Females are more likely to get this problem than males.
There are a number of risk factors that increase the risk for the injury. One of the more common factors is abnormal foot biomechanics, such as a foot that rolls too much inwards at the ankle joint. This is called pronation and puts a twist through the leg bone and overloads the part of the tibia bone that gets injured. A tight calf muscle is also considered a factor. Poor training principles have also been implicated. This includes doing too much running too soon when the amount of training done should be to build up slowly. Another common factor is the running shoes being too warn. This can cause alignment problems of the foot and lower limb.
The initial pain from MTSS usually starts about halfway up the leg towards the inside. It may not initially hurt when running, but does become painful when palpating the area. As the condition progress (assuming no treatment was implemented) it becomes increasingly painful and can start to interfere with the running.
The initial treatment usually starts with a modification to the training routine, such as cutting back on the amount of running. If necessary, cycling or swimming can be substituted to maintain fitness. The foot biomechanics can be addressed with the use of foot orthotics. There have been recent suggestions that medial tibial stress syndrome can be treated with medial foot wedging in the shoes. Advice from a specialty running shoe store should be sought for the most appropriate running shoes. Calf muscle stretching is also an important part of the rehabilitation. Sometimes other physical therapy treatments and anti-inflammatory medication is needed. After the condition starts to settle, a gradual return to full running activity is necessary. A too rapid return to a full training program is associated with a high chance of recurrence.
