Medial Tibial Stress Syndrome: A Scoping Review of Epidemiology, Biomechanics, and Risk Factors

Regular physical activity confers numerous health and social benefits; however, activity-related lower-limb overuse injuries are prevalent. Medial tibial stress syndrome (MTSS) is a common overuse injury of the lower extremity. It is frequently observed in athletes and in military personnel. It involves exercise-induced pain over the anterior tibia and is an early stress injury in the continuum of tibial stress fractures (TSF). This scoping review aims to synthesize and characterize the literature on MTSS, identify knowledge gaps, and propose future research directions. We conducted a scoping review of the literature, which was informed by the Joanna Briggs Institute and the Arksey and O'Malley methodology, by searching four databases until December 31, 2023. The references were screened by two authors based on their titles, abstracts, and full texts to ensure that they met the inclusion criteria. Data related to the research objectives were extracted, analyzed, and reported numerically and descriptively. Thirty-seven studies were included in the current review, most of which recruited athletes as the study participants (67.6%). This was followed by articles about military members (16.2%). The highest prevalence of MTSS has been reported among recreational marathon runners in India (69.5%). The highest incidence of MTSS was reported in a German study (35.7%). Two studies reported that participants with MTSS had a higher body mass index (BMI) than those without MTSS, and one study found a significant correlation between BMI and the time required for complete recovery. Two studies reported that individuals with greater experience in athletic activities were at a lower risk of developing MTSS later in their careers. In contrast, another study reported that ultramarathon running increases the incidence of MTSS overuse injuries. Traction theory as a cause of MTSS was examined in five studies, and the mean navicular drop test (NDT) score was assessed in three studies. Biomechanical evaluation of ankle disorders and MTSS was performed in five articles and hip abnormalities in four articles. This review identifies research areas on the influence of epidemiological, risk, and biomechanical factors on MTSS development. Such research could inform counseling for patients concerned about MTSS risk factors and curative measures, as well as optimize surveillance and subsequent management of MTSS outcomes.