Medial Tibial Stress Syndrome

Condition

This is one of the conditions that can contribute to exercise induced leg pain and is often termed shin splints. This is more common in runners or sports such as football, hockey and rugby. Symptoms are generally on the inside of the lower leg and may be either fairly localised or over a larger area. The symptoms tend to follow the length of the shin bone (tibia) sitting on the edge of the bone although it can affect the associated muscles.

What causes medial tibial stress syndrome?

This is generally caused by overuse due to increasing training levels too quickly, harder grounds or too much activity without sufficient rest. Poor running technique, inappropriate shoes or poor lower limb function can contribute to the condition. There is some evidence that increased rotational forces within the leg bone (tibia) can increase the stress to the bone. This cannot be measured by video analysis and requires 3D gait analysis.

Will it get worse?

Left un-treated, most musculoskeletal problems deteriorate, eventually causing reduced activity. This is particularly true of medial tibial stress syndrome and if it becomes chronic, it can take several months to settle.

What are the common symptoms?

• It generally starts as an ache in the leg during activity or the day after.
• The speed of onset, duration and intensity of symptoms gradually increases.
• The time it takes to settle after exercise gradually becomes longer and exercise itself may not be possible.

How is it recognised?

• Clinical examination and a detailed history allow diagnosis.
• A detailed 3D gait analysis can help to diagnose the contributing factors, particularly the rotational forces within the legs.
• When necessary an ultrasound scan or MRI scan can help diagnosis.
• Bone scans can be used but have generally been replaced by MRI scans.

What can I do to reduce the pain?

There are several things that you can do to try and relieve your symptoms:

• Rest and ice can help.
• Ensure that you have appropriate running shoes and perform some basic flexibility and strengthening exercises.
• See a podiatrist

What will Premier Podiatry do?

If simple measures do not reduce your symptoms, there are other options:

• Confirm the diagnosis / arrange any necessary investigations
• Perform a detail 3D gait analysis to diagnose the under lying factors that may contribute to injury.
• Advise appropriate shoes
• Advise exercises
• Consider prescribing orthotics. We have some specific modifications we use for this condition to help it settle.
• Consider using shockwave therapy. There is some evidence that this can help reduce symptoms in conjunction with the conservative management programme.

The way in which your foot loads during walking can place increased stress on the foot and this can be controlled by special shoe inserts (orthotics). Whilst these do not correct the position of your foot, they guide motion to reduce symptoms and the risk of further injury.

In many cases orthotics are only required for a short period of time to help resolve symptoms whilst function is improved with an appropriate rehabilitation plan. Our sophisticated 3D gait analysis allows us to advise patients the length of time they will require orthotics.

Will this cure the problem?

In the vast majority of cases, the conservative treatments are sufficient to resolve the symptoms and allow a return to activity. However, there is always a risk of recurrence if your training programme is incorrect.

What will happen if I leave this alone?

This condition generally gets worse unless it is managed properly and will affect your ability to exercise.

What happens if the treatments do not work?

In rare cases, surgery may be required. This generally involves releasing the soft tissues from the underlying bone.