some data here

Dear Alia

This paper may be useful for you

Curr Rev Musculoskelet Med. 2009 Sep; 2(3): 127–133.

Medial tibial stress syndrome: conservative treatment options

R. Michael Galbraithcorresponding author and Mark E. Lavallee

Thank you Dr Emmanuelle Cugy

Thank you Dr Nelson Elias

In the acute case - rest, ice massage, and gentle Achilles tendon stretching  3 to 4 times a day. NSAID. Gentle stretching of the leg muscles that includes the calf, heel cord, and hamstrings.   

Anyway, the key treatment is rest from the activity that causes the pain. Once the pain has subsided, less stressful exercises can begin, i.e. swimming to substitute running. The exercises should be gradually increased over 3 to 6 weeks. Any pathoanatomic foot problem, such as a pronated flat foot, should be corrected with a semirigid shoe insert. 

If the symptoms do not respond with long periods of rest (after several months, sometimes a year !), a patient may undergo surgery to release the soleus attachment to the tibia. These stubborn cases are rare. 

You should try also therapies with shockwave. 2-3 sessions one per week. After the treatment is over check for the biomechanic parameters of the patient with baropodography and prescribe custom made insoles

Hey Alia,

A few other references that might be of use to you:

Treatment of medial tibial stress syndrome: a systematic review.

Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW.

Sports Med. 2013 Dec;43(12):1315-33. doi: 10.1007/s40279-013-0087-0. Review.

https://www.researchgate.net/publication/256120208_Treatment_of_Medial_Tibial_Stress_Syndrome_A_Systematic_Review

The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial.

Moen MH, Holtslag L, Bakker E, Barten C, Weir A, Tol JL, Backx F.

Sports Med Arthrosc Rehabil Ther Technol. 2012 Mar 30;4:12.

https://www.researchgate.net/publication/223992616_The_treatment_of_medial_tibial_stress_syndrome_in_athletes_a_randomized_clinical_trial

Hope that helps

Article Treatment of Medial Tibial Stress Syndrome: A Systematic Review

Article The treatment of medial tibial stress syndrome in athletes; ...

Thank you  R. Scattone Silva, your answer is very helpful. 

One of the problems with MTSS is that we lack a good pathophysiologic understanding of what exactly it is.  While more recent literature suggests it is a bone stress injury, there is sufficient histologic evidence to suggest it also involves the fascia and periosteum.  Almost all runners show changes in tibial bone structure on high resolution CT scan, and yet only 40% of those with changes were symptomatic, pointing to other causes.  ECSW has shown some promise, but it's effect is difficult to determine.  It may cause die back of small periosteal  nerves, but it also has effects on the bone itself.  Unlike low dose pulsed ultrasound those effects are delayed for about 21 days after treatment, so early relief is probably of neurologic mechanisms.  What is known is that orthotics are not the "cure".  Soleus endurance may be a factor in some cases.  Neoprene innersoles showed some effect in two studies.  Unfortunately there are no good papers summarizing all of this at present.

MTSS means pain at medial tibia due to overloading. In general, the involved soft tissue, periost and or bone becomes painful, the biomech. chain shortens.The reasons are many, not just the suddenly increase of training intensity (distance, speed, hills), also subtle changes in posture. In general, treatment means decrease the overload/ rest. Loosen the muscles/ fascias of the feet, calf und femur- black roll, stretching, massage, shockwave etc. Often the feets are overpronated- use then insoles with antipron. support., or try to overcome different  feetpositions and subtle normalise the position. Look for other ailments. Sometimes there might be a local issue like a plantar wart or ingrown toenail  triggering the problems. Start specifical training for muscles of the feet und gluteals, since both have influence at limb rotation/ posture, thus resulting in releasing the the insertional tension at medial tibia. Be sure there is no hidden fracture- if suspected at the tibia, MRI is the best diagnostic tool.  If the pain is somewhat difficult to locate, bone scan.

Another cause might be the leglength discrepancies- e.g dynamic- functional by ileosacral or lumbal blockade, contractur (adductors often) or a real leglength difference. If so, use a stepwise 3mm approach in length compensation over a 12mth period and not immediat 1,5cm.

If the pain is more like burning, the sensibel branch of the femoral nerve at the med. calf- the saphenus nerve, could be irritated at the hunters canal. (Check for sensoric/ tingeling/ numbness and sweatsecreation- means dry skin).

Hope it helps, JE