How Medial Tibial Stress Syndrome Is Affected by Alignment, Range of Motion, Strength, and Gait Biomechanics: A Systematic Review and Meta-Analysis.

Medial tibial stress syndrome, often called shin splints, is a common overuse injury in physically active people, but which physical traits actually raise the risk has been unclear. This systematic review and meta-analysis pooled data from 21 studies looking at lower-limb alignment, joint range of motion, muscle strength, and walking or running mechanics in relation to MTSS. Pooled results identified five factors significantly associated with MTSS: a higher foot posture index (flatter foot posture), greater intercondylar interval (knee gap distance), increased ankle inversion range of motion, greater ankle eversion strength, and larger dynamic arch height change during walking. The authors noted publication bias in several variables, though adjusting for it using the trim-and-fill method made little difference to the results.

Because this is observational, pooled evidence, these associations do not establish that these traits cause MTSS.

Shin splints, medically known as medial tibial stress syndrome, are a common source of lower-leg pain in runners and other active people, but doctors and researchers haven't been fully sure what physical characteristics make someone more likely to develop it. To explore this, researchers combined findings from 21 previously published studies examining things like foot shape, joint flexibility, muscle strength, and walking patterns in people with and without this condition. The combined analysis found five factors that were statistically linked to having MTSS: flatter foot posture, wider spacing between the knee bones, more inward ankle flexibility, stronger outward ankle muscles, and bigger changes in foot arch height while walking.

It's important to understand that these are associations found by combining many different studies, not proof that any of these traits directly causes shin splints. The researchers also found some evidence of publication bias, meaning studies with certain results may have been more likely to get published, though correcting for this didn't meaningfully change the overall findings.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis synthesized 21 studies examining lower-extremity alignment, range of motion, strength, and gait biomechanics as potential risk factors for MTSS, aiming to clarify a body of research that has produced inconsistent findings. Pooled analyses identified five variables with statistically significant associations: foot posture index (SMD 1.23, 95% CI 0.02-2.43), intercondylar interval (SMD 0.29, 95% CI 0.10-0.48), inversion range of motion (SMD 0.37, 95% CI 0.10-0.63), eversion strength (SMD 0.37, 95% CI 0.10-0.65), and dynamic arch height change during walking (SMD 1.05, 95% CI 0.49-1.60). Egger's regression indicated asymmetry suggestive of publication bias in several variables, and trim-and-fill adjustment was applied, with the authors reporting minimal impact on effect estimates.

The wide confidence interval for foot posture index in particular signals imprecision despite reaching significance. As with any meta-analysis of observational risk-factor studies, these findings represent cross-sectional associations rather than causal or predictive relationships, and heterogeneity across included study populations and measurement methods was not detailed in the abstract, limiting certainty about generalizability.