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Medial Tibial Stress Syndrome


What is Medial Tibial Stress Syndrome?


Medial tibial stress syndrome falls under the umbrella term shin splints. Shin splints refer to any pain in the shin area regardless of the actual diagnosis. MTSS is a more specific diagnosis that refers to the tibia bone, the shin bone becoming over-stressed. It is usually not serious though it can stop people from exercising and can lead to more serious bone injuries such as stress fractures if it is not treated properly.


What are the symptoms of Medial Tibial Stress Syndrome?

Pain is usually located along the lower 3rd of the medial edge of the tibia. You can find the medial edge of the tibia if you find the nobly part of your ankle and run your fingers up the bone toward your knee.


Pain is usually spread out and feels like a dull ache. If pain is more pinpoint and sharp, the injury is more likely to be a stress fracture.


What causes Medial Tibial Stress Syndrome?

Ultimately MTSS is caused by abnormal bending of the tibia over a prolonged period of time. The most common cause for this training error increasing running miles or exercise too rapidly without allowing enough time for the body to adapt to the new level of training.


Other contributing factors can be people's natural bone shape. People with more bowed tibias tend to suffer from MTSS more than those with straighter tibias. Running technique can also be a factor, with cross-over gait and hip drop being common gait characteristics linked to MTSS. Cross-over gait is one-foot landing in front of the other, leading to increased bending forces travelling through the bone. Widening step width can significantly reduce bending forces on the bone.


For females, changes in hormones during monthly cycles and menopause can also lead to an increased risk of symptoms.

How is MTSS treated?


In the short term, we aim to reduce the load on the injured bone. This usually requires a decrease in exercise levels. We rarely advise stopping exercise. Our aim is to exercise at a level where the pain is mild but not uncomfortable. Foot orthoses and special insoles can be used to help with this. Laser therapy can also be used as it helps to reduce inflammation and encourages faster bone development.

Once we have control of the symptoms, we can start looking at longer-term treatments which aim to prevent the injury from occurring again. These treatments can consist of:

  1. Foot orthoses to help improve foot function. This is often the cause for people who have naturally more bowed tibias.

  2. Gait re-education – Changing how you run or walk reduces stress on the tibia. This often involves running with wider feet and running with increased cadence, how many steps per minute are taken.

  3. Improving muscle strength. Muscles help to absorb impact forces; the more force they can withstand, the better.

Long-term treatment also involves keeping the rest of the body strong whilst normal exercise levels are reduced. This helps to decrease the risk of further injury when returning to sport.


If you feel like you are suffering from MTSS and would like a professional second opinion, contact us today to book an appointment.



*This blog contains general information about medical conditions and is not advice. You must not rely upon the information in this blog as medical advice. Medical advice should always be sought from an appropriately qualified podiatrist such as ourselves.

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