Treatment recommendations for elite athletes with MTSS

1. Pneumatic leg brace for weightlifting activity until pain free
2. Avoidance of nonsteroidal anti-inflamatory drugs
3. Use of cryotherapy for control of pain and swelling
4. Foot orthoses with varus wedge, rearfoot to forefoot to sulcus, as appropriate
5. Radial soundwave therapy and/or focused extracorporeal shockwave therapy to affected area
6. Relative rest (decreased impact; ie, aqua, jogging, cycling, elliptical machine)
7. Use of AlterG^TM treadmill
8. Assessment of vitamin D3, nutrition status (ie, disordered eating, relative energy deficiency in sports)
9. Assess shoes and sport surface
10. Access core strength, limb length and muscle imbalances

From Saxena et al, Journal of Foot & Ankle Surgery 2017