w w w . m a r s h f i e l d c l i n i c . o r g

Medial Tibial Stress Syndrome Care

Instructions for recognition, treatment and rehabilitation of the common lower leg injury

Resisted eversion: Turn your injured foot up and out, stretching the tubing.

Static and dynamic balance exercises: Stand on injured leg for 30 seconds with different surfaces (floor, pillow) and close your eyes.

Return to ActionYour return to sports should be decided in consultation with a sports medicine specialist, based on your symptoms and function.

Treatment/exercise recommendations

l Compression wrap

l Ice

l Exercises/rehabilitation

l Follow-up

l Other

Special instructions _____________________

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Provider ________________________________

Phone __________________________________

If symptoms worsen or do not improve, consult your healthcare provider promptly.

098-015 (04/09) © 2009 Marshfield Clinic

What is medial tibial stress syndrome (MTSS)This is a catch-all term that describes pain in the front or inside of the lower leg, occurring from repetitive microtrauma.

Symptoms:

•Aching/pain

•Inabilitytobearweight or perform activity

•Decreasedrangeofmotion/strength

Additional possible related injuries:

•Tibialstressfracture

•Compartmentsyndrome

•Fibularstressfracture

•Periostitis

TreatmentRest

Limit activity until pain decreases and weight-bearing is tolerable. You may need crutches.

Motion

•Maintainpain-freeanklerange of motion

•Stretchthecalfmusclesuntilyou feel slight discomfort.

Ice/cold therapy

•Icebagfor20minuteseveryhour

•Iceslushbath,lessthan15minutes

•Icemassagefor10–12minutes (rub ice in cup over area)

•Useiceforaminimumofthreedays

Footwear

* Ensure that foot wear is appropriate for the activity, and fits the foot well

•Replacewornshoesinatimelymanner

Rehabilitation

Your progression to rehabilitation will depend on strength, range of motion, and pain. Rehabilitationexercisesfocusonimprovingrange of motion and increasing strength.

Perform these exercises two times per day:

Stretches hold for ____ seconds _______ reps

Strengthening _______ sets _______ reps

MTSS ExercisesTowel stretch: Loop a towel around the ball of your foot and pull the towel toward yourbody,keepingyourkneestraight.

Ankle range of motion: Sitting or lying down with your legs straight, moveyourankleup and down, in and out, and in circles.

Standing calf stretch: Turn your injured foot slightly inward and push heel into floor. Slowly lean into the wall until you feelastretchinthebackofyourcalf.

Standing soleus stretch: Stand facing a wall with your hands at about chest level. Withbothkneesslightlybentandtheinjuredfootback,gentlyleanintothewalluntil you feel a stretch in your lower calf.

Resisted dorsiflexion:Usingastretchabletube placed around the leg of a table or heavy chair, pull your foot toward your bodywhilekeepingyourkneestraight,stretching the tubing.

Resisted plantar flexion: Gently press the ball of your foot down and point your toes, stretching the tubing.

Resisted inversion: Turn your injured foot inward and upward, stretching the tubing.