Evidence-Based Management of Medial Tibial Stress Syndrome in Runners

Purpose of Review To present a synthesis of recent literature regarding the risk factors and management for MTSS. Recent Findings Risk factors include female sex, prior history of MTSS, less running experience, female athlete triad/RED-S, higher BMI, smoking, and biomechanical abnormalities. Management includes activity modification, gait retraining, orthotics, medications, and, very rarely, surgery. MTSS is an overuse injury commonly seen in runners. The pathophysiology remains disputed, and diagnosis is often determined from clinical presentation alone. For unclear reasons, women are at increased risk for development of MTSS. Other risk factors include increased BMI, prior history of MTSS, less running experience, smoking, presence of at least one component of the female athlete triad/RED-S, and biomechanical abnormalities. Treatment often includes cessation of high-impact activity, gait retraining, neuromuscular training, and orthotics. In rare circumstances, surgery may be considered. Identifying risk factors is important for prevention and individualized management.