What it is
Medial tibial stress syndrome (MTSS), commonly known as shin splints, is exercise-related pain along the inner (posteromedial) border of the tibia. It is an overuse injury frequently seen in runners and soldiers and represents a spectrum of bone/soft-tissue loading responses rather than a single pathology.
Common causes / risk factors
- Sudden increase in training volume or intensity, running on hard or cambered surfaces, inadequate recovery, poor footwear, and biomechanical issues (excess pronation or muscle weakness).
- Muscle fatigue and altered loading patterns are key contributors.
Symptoms
- Diffuse pain along the medial tibia that is worse during and after exercise, often improving with rest. Tenderness when palpating a length (>5 cm) of the tibia is common.
Evidence-based treatments
- Activity modification (reducing load), relative rest, graduated return to activity, and physiotherapy-led strengthening and conditioning programs.
- Shock absorption (footwear, running surface), gait retraining, and addressing muscle imbalances can help prevent recurrence.
- Evidence for specific modalities (e.g., compression, manual therapy) is mixed; the primary focus should be load management and progressive strengthening.
How Clear Step Podiatry can help
- Detailed gait and load-analysis to identify training errors and biomechanical contributors.
- Individualised rehabilitation plan (strengthening, calf/foot drills, gradual return to running) and footwear/orthotic recommendations to reduce tibial stress.
- Structured follow-up and coordination with allied professionals (physio/strength coach) when necessary to safely progress training.
