Introduction: Medial tibial stress syndrome (MTSS) is an overuse injury and one of the most common cause of shin pain in athletes. The etiology of MTSS is not yet clarified, but the recent studies have shown that MTSS is a stress reaction of the tibia due to micro-bending, tension of soft-tissue structures or combination of both. MTSS is defined as pain in the area of the distal two-third of the posterior medial edge of tibia and appears with exercise. More accurate understanding of the pathophysiology of MTSS would make it easier to define risk factors of MTSS. Purpose: The purpose of this diploma work is to review the existing literature and present the risk factors for medial tibial stress syndrome. Methods: Studies were searched in the PubMed database. Results: Nine randomised controlled trails were included in this diploma work. Women are more vulnerable to the MTSS compared with men. Decreased flexibility of the transverse arch and decreased medial longitudinal arch ratio are risk factors for MTSS. The external risk factors for MTSS are poor gait biomechanics and history of MTSS. Low aerobic fitness and smoking habit were demonstrated as additive external risk factors for MTSS. Internal risk factors for MTSS are decreased or increased hip internal ranges of motion, increased plantar ankle flexion, changed standing foot angle, excessive navicular drop, the difference in length of the lower limbs and increased body mass index. Conclusion: Evaluation procedures of risk factors for MTSS should be standardised and carried out by a qualified professional for comparable, valid and reliable results. A stronger and more accurate evidence of risk factors for MTSS and their influence on the phenomenon of MTSS would significantly increase the opportunities for appropriate and quality prevention and treatment.
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