Anatomical and Biomechanical Assessments of Medial Tibial Stress Syndrome

The purpose of this study was to elucidate selected anatomical, dynamic and static biomechanical factors of MTSS.

Each participant completed a General Health History Questionnaire to assess their general health.

Participants also completed the Medial Tibial Stress Syndrome Injury History Questionnaire, along with a physical examination to differentiate between individuals with MTSS and non-injured controls.

A variation of the visual analog pain scale developed by Melzack was used to assess resting pain and retrospective pain during exercise.

The foot and ankle flexibility measures assessed were: active ankle dorsiflexion with the knee at 0° extension and 90° flexion, passive extension of the first metatarsophalangeal joint during weightbearing and non-weightbearing, and arch height index ratio during sitting and standing.

Foot type was classified according to foot function, allowing for the determination of pes planus and rectus.

Foot function was determined statically using the malleolar valgus index and dynamically using the centre-of-pressure excursion index.

The initial pronation index, a novel measure of dynamic foot function, was used for the first time in this study.

The Modified Baecke Physical Activity Questionnaire was used to quantify the activity level of the study participants.

Although limb length was assessed during non-weightbearing, the 0.16-cm difference between participants with MTSS and non-injured controls, may be clinically relevant under increased loads.

A trend was established in dorsiflexion at 0° knee extension for participants with MTSS as compared to the non-injured controls.


  1. Katherine E. Bartosik, Michael Sitler, Howard J. Hillstrom, Howard Palamarchuk, Kellie Huxel, Esther Kim (2010) Anatomical and Biomechanical Assessments of Medial Tibial Stress Syndrome. Journal of the American Podiatric Medical Association: March/April 2010, Vol. 100, No. 2, pp. 121-132

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