Medial tibial stress syndrome (MTSS), or commonly known as “shin splints”, describes exercise-induced pain that occurs along the inside of the lower leg. It is considered as the most common injury in runners, with an approximate 13.2-17.3% of runners experiencing this injury. MTSS is also found in athletes participating in high intensity sports, such as soccer, football, basketball,
MTSS is recognised as an overuse condition, wherein the muscles that originate along the inside of the tibia accumulate a load greater than what it is able to handle. This can come about through a combination of impact forces from the ground and traction of the muscles originating along the inner side of the tibia.
Risk factors that can contribute to the development of MTSS include:
- Training errors – overtraining or a sudden increase in training; training on hard or uneven surfaces
- Improper footwear
- Weak plantarflexor muscles
- Pronated (or flat feet) foot posture – causes muscles originating along the tibia to overwork and become overloaded to maintain arch height of the foot
- Supinated (or high arched) foot posture – results in an rigid foot that has limited shock absorption and increasing impact pressure on the tibia
- Improper nutrition or rest
Treatment of MTSS aims to reduce symptoms whilst targeting the underlying factors that are causing the injury. Management of MTSS
- Reducing symptoms – pain relief medications (paracetamol and/or oral/topical NSAIDs), icing, compression, taping/strapping
- Load management – initially reducing load with the plan to later build back up to pre-injury load. Load management may involve modifying exercise intensity, volume, frequency, and even training surfaces.
- Strength and conditioning – strengthening muscles along the inner side of the tibia to increase its load capacity
Treatment of MTSS will be varied and needs to be assessed and treated based on the individual. Managing MTSS may also involve:
- Orthotic therapy – useful in cases where foot posture is a contributing factor
- Shockwave therapy – shown to be effective in chronic presentations (greater than three months)
- Footwear advice & prescription
It is important that MTSS is managed as soon as it manifests. Your podiatrist will be able to assess the underlying factors causing the injury and provide a personalised management plan.
Pro Podiatry SA, Tien Nguyen, Podiatrist