Ask Steph April 2019

Several of my track friends ask, about an issue that could be addressed. So right now we have several athletes that are new to distance running and track and field as a whole that are experiencing medial tibial stress syndrome (shin splints).Our trainer recommended this,  So the importance of good mechanics, calf stretching, and proper support under their feet play a big role in treating and preventing that condition. What is your medical option with this?

Response from Indiana Podiatry Group  Dr. Scott Kilberg

The term medial tibial stress syndrome was first used in the early 1980s as an alternate to the more common and inaccurate term of ‘shin splints’.  There are a number of athletic and exercise caused lower leg injuries that can develop, and medial tibial stress syndrome is one of them.  Most people who develop this condition are runners or jumpers, and more females than males tend to develop it.  Symptoms include pain in the front of the leg along the inner side of the ‘shin’, or tibia bone.  This pain typically only occurs with activity, and quickly goes away within 5 minutes of stopping the activity.  If the pain continues after this, even with only light walking, a stress fracture could be present which a completely different condition is.

The actual biologic cause behind this condition is not exactly known.  It is theorized that since bone is a substance that remodels itself and grows less dense due to stress, followed by a period of strengthening and increased density, there is a point in which the bone strengthening gets interrupted and in some athletes the bone becomes damaged following this stress when there is not enough time for the bone to rest and strengthen.  This may be what is occurring in the tibia.  Other considerations include possible traction of the muscles in the lower leg that attach to the tibia, as well as bending force on the tibia during running and jumping.

Treatment of this condition includes icing to the front of the leg as well as full rest or at least reduced running on soft surfaces or cross training with cycling, swimming, and pool running.  Recovery can take up to 4 months, and in severe cases, the leg may need to be immobilized in a walking boot.  Physical therapy can also play a role in treatment.

From a mechanical perspective, it is important that athletes reduce the amount of pronation, or ‘flattening’ of their feet.  Research shows increased pronation of the foot is linked to an increased chance of developing medial tibial stress syndrome.  The use of arch support to reduce this pronation can play a role in prevention.  Other ways to prevent this condition include ensuring training programs do not overload the start with too much training activity, as well as ensuring any running occurs level surfaces with moderate, but not excessive, firmness.  Proper flexibility is important, with adequate calf and leg stretching necessary to keep the leg moving optimally without added strain.  The use of sports specific shoes is important, and for runners the changing of running shoes every 250-300 miles is recommended.  Proper nutrition, including calcium and protein, plays a large role in the health of bone and needs to be considered as a preventative measure.  Even hormonal imbalance can alter the health and strength of bone, with issues seen in both women and men that may need medical attention.