Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors

J Orthop Sports Phys Ther. 2007 Feb;37(2):40-7. doi: 10.2519/jospt.2007.2343.


Study design: Prospective cohort.

Objective: To determine (1) the cumulative seasonal incidence and overall injury rate of medial tibial stress syndrome (MTSS) and (2) risk factors for MTSS with a primary focus on the relationship between navicular drop values and MTSS in high school cross-country runners.

Background: MTSS is a common injury among runners. However, few studies have reported the injury rate and risk factors for MTSS among adolescent runners.

Methods and measures: Data collected included measurement of bilateral navicular drop and foot length, and a baseline questionnaire regarding the runner's height, body mass, previous running injury, running experience, and orthotic or tape use. Runners were followed during the season to determine athletic exposures (AEs) and occurrence of MTSS.

Results: The overall injury rate for MTSS was 2.8/1000 AEs. Although not statistically different, girls had a higher rate (4.3/1000 AEs) than boys (1.7/1000 AEs) (P = .11). Logistic regression modeling indicated that only gender and body mass index (BMI) were significantly associated with the occurrence of MTSS. However, when controlled for orthotic use, only BMI was associated with risk of MTSS. No significant associations were found between MTSS and navicular drop or foot length.

Conclusions: Our findings suggest that navicular drop may not be an appropriate measure to identify runners who may develop MTSS during a cross-country season; thus, additional studies are needed to identify appropriate preseason screening tools.

MeSH terms

  • Adolescent
  • Athletic Injuries
  • Cohort Studies
  • Cumulative Trauma Disorders / epidemiology*
  • Cumulative Trauma Disorders / etiology
  • Female
  • Humans
  • Leg Injuries
  • Male
  • Prospective Studies
  • Risk Factors
  • Running*
  • Syndrome
  • Tibia / pathology*