The Incidence and Risk Factors in the Development of Medial Tibial Stress Syndrome among Naval Recruits

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Abstract
Purpose: To identify the incidence of medial tibial stress syndrome (MTSS) in a group of naval recruits undergoing a 10-week basic training period and to determine potential risk factors. Method: One hundred and twenty-four recruits (84 men and 40 women) were followed prospectively during basic training. Anthropometric and lower limb biomechanical data were recorded at the start of the program along with injury history and previous sporting activity for the 3 months prior to enlisting. Recruits were monitored during training for development of medial tibial strees syndrome and were asked to complete an exit interview at the end of the program. Results: Forty recruits (22 men and 18 women) developed medial tibial stress syndrome, giving an incidence of 35%. A significant relationship existed between gender and medial tibial stress syndrome (P= .012), with female recruits more likely to develop medial tibial stress syndrome than male recruits (53% vs 28%). A risk estimate revealed a relative risk of 2.03. The biomechanical results indicated a more pronated foot type (P= .002) in the medial tibial stress syndrome group when compared to the control group. A risk estimate established that recruits with a more pronated foot type had a relative risk of 1.70. Conclusion: Identifying a pronated foot type prior to training may help reduce the incidence of medial tibial stress syndrome by early intervention to control abnormal pronation. Findings of a higher incidence of medial tibial stress syndrome among female recruits require further investigation.