The Medial Tibial Stress Syndrome (MTSS) refers to recurrent exercise-induced pain over the middle and distal third of the posteromedial tibia. It is an overuse injury that may be related to one or more mechanisms.


Risk groups:

(1) runners, especially those with abnormal foot pronation

(2) jumpers (volleyball, basketball, long jumping)

(3) aerobic dancers

(4) military recruits



(1) The pain is induced by exercise over the posteriomedial border of the tibia.

(2) The pain may persist for hours or even days after the exercise.

(3) The pain may be focal or diffuse (focal pain suggests stress fracture; Yates et al use 2-3 cm for focal pain).

(4) The patient may experience discomfort on palpation.


Underlying Mechanism

Type (Detmer)

stress fracture or bone stress reaction


periostitis (fascial origin of the soleus muscle; at the origin of the tibialis posterior muscle)


chronic posterior compartment syndrome



Imaging studies that can help identify the cause:

(1) bone scan with technetium pyrophosphate

(2) magnetic resonance imaging (MRI)


Compartment pressure readings can help identify a compartment syndrome.


The diagnosis requires exclusion of other causes (infection, tumor, muscle injury, etc.).


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