Medial Tibial Stress Syndrome
(MTSS; Shin Splints; Medial Distal Tibial Syndrome, MDTS; Medial Tibial Syndrome; Stress-Related Anterior Lower Leg Pain; Spike Soreness)
Medial tibial stress syndrome (MTSS) is shin pain from overuse or repetitive stress.
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MTSS happens when muscles and tendons over the shin become irritated and inflamed. It is caused by a sudden increase in activity levels.
This problem is more common in people who do repetitive, high-impact activities, such as:
- Military training
Other things that may raise the risk are:
- Increasing activity levels too quickly
- Flat feet or stiff arches
- Poor footwear
The main problem is sharp or dull pain along the shinbone. Other problems may be:
- Pain during and after activity
- Pain when touching the shin
The doctor will ask about your symptoms and health history. A physical exam will be done. It will focus on the shin. This is often enough to make the diagnosis.
Images of the shin may be taken to check for other problems. This can be done with:
The goal of treatment is to manage symptoms and promote healing. Rest will be needed for several weeks. Other choices are:
- Supportive care, such as cold packs, bandages, and elevating the leg
- Medicines to ease pain and swelling
- Supportive shoes, a brace, or a walking boot to take pressure off the shin as it heals
- Physical therapy to help with strength, flexibility, and range of motion in the lower leg
People who do not get better with these methods may need surgery. This is not common.
The risk of this problem may be lowered by:
- Slowly increasing physical activities
- Wearing proper footwear for sports and activities
Ortho Info—American Academy of Orthopaedic Surgeons
Sports Med—The American Orthopaedic Society for Sports Medicine
The Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Robertson GA, Wood AM. Lower limb stress fractures in sport: Optimising their management and outcome. World J Orthop 2017 Mar 18;8(3):242.
Shin pain. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/shin-pain. Accessed February 18, 2021.
Shin splints. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/shin-splints. Accessed February 18, 2021.
Shin splints. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/injuries-poisoning/sports-injury/shin-splints. Accessed February 18, 2021.
Last reviewed December 2020 by EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT Last Updated: 2/18/2021