Lower leg brace helps reduce pain in medial tibial stress syndrome

A pilot run for a lower leg brace designed for patients with medial tibial stress syndrome (MTSS) has shown a decrease in MTSS symptoms from 5 weeks up to over 6 months, with a lower recurrence rate, compared with placebo.

“[T]his pilot randomized controlled trial [RCT] demonstrated [that] the lower leg brace reduced MTSS pain symptoms and recurrence, and it facilitated earlier return to full activities and provided symptom relief up to 6 months,” the researchers said.

This prospective double-blinded, placebo-controlled RCT was carried out in two private sports medicine practices. Individuals with symptomatic MTSS lasting 6 weeks or more were included, while those with other lower limb pathologies were not. Overall, 14 eligible participants wore the brace or placebo.

The brace worked by applying counterforce pressure to the musculotendinous junctions of the soleus, compressing periosteum at the distal third of the posteromedial tibia, and applying inferomedial torsion to the soleus muscle.

The researchers recorded additional treatment modalities, while participants completed a standardized MTSS Severity Score at 0‒6, 8, 12, and 24 weeks and recorded their return to full activity.

Participants who used the lower leg brace demonstrated a significant reduction in MTSS severity score from 5 to 24 weeks (p<0.03) and had returned to full activity within 5 weeks. On the other hand, individuals in the placebo group showed no change in their MTSS scores (p>0.05). [BMJ Innovations 2023;9:257-263]

Notably, all participants with the placebo experienced MTSS recurrence, and none of them were able to return to full activity over 24 weeks.

“These results are promising and provides clear implications for a future RCT with a larger sample size that would have greater power and closely scrutinize clinical significance,” the researchers said.

“If similar results are seen in a larger cohort, [this device] has potential to benefit patients with MTSS as an adjunct to current treatment modalities,” they noted.

Previous studies have also examined the benefits of a lower limb brace in patients with MTSS. [Mil Med 2006;171:40-44; J R Army Med Corps 2010;156:236-240; Sports Med 2013;43:1315-1333]

One study that investigated the use of a rigid rod spanning the length of the posteromedial tibia reported no beneficial effects, while another that assessed a pneumatic brace commonly used for tibial stress fractures fell short of demonstrating efficacy. [Sports Med 2013;43:1315-1333; Int J Sports Phys Ther 2012;7:279-287]

Additionally, a study on the use of the popular calf compression sleeves also showed no benefit. [Sports Med Arthrosc Rehabil Ther Technol 2012;4:12]

“In comparison, our study used a compression sleeve as a placebo compared with the brace with a low withdrawal rate and good compliance,” the researchers said. “This may be attributed to having a small group of highly motivated participants and regular follow-up.”

The current study was limited by its small sample size, according to the researchers.