The SHIFT Project 13 - MTSS: Wrong Mechanics, Wrong Orthoses
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The SHIFT Project 13 - MTSS: Wrong Mechanics, Wrong Orthoses
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This podcast re-evaluates Medial Tibial Stress Syndrome (MTSS) through a kinetic lens, asserting that the injury is a bone-stress pathology driven primarily by excessive varus tibial bending leading to dangerous tensile loads on the medial tibial cortex. The content argues that the traditional orthotic approach, which focuses on controlling foot pronation (a kinematic correlate), fails to address the underlying kinetic problem of the medialized location of the ground reaction force (GRF) relative to the tibial shaft. Conventional anti-pronation devices, such as those employing varus posting, are criticized for potentially exacerbating the injury because they often inadvertently shift the GRF further medially, increasing the very bending moment associated with MTSS. Accordingly, the author proposes an alternative kinetic orthotic strategy grounded in mechanical evidence, which aims to directly reduce tibial stress by employing material stiffness to lateralize the GRF and reduce overall midfoot impulse. This shift from a kinematic to a kinetic paradigm offers a more mechanically coherent path forward for managing MTSS compared to historically relied-upon pronation-control methods.