Sixty fasciotomies of the deep posterior compartment were performed on 30 patients with longstanding bilateral medial tibial syndrome (mean duration 25 months). The initial symptoms occurred during sports activities in all cases. Only 2 of the athletes were able to continue sports at an ordinary activity level. The diagnosis was based on a typical history of longstanding exertional pain and clinical findings of tenderness at the postero‐medial border of the tibia. Radiographs showed no abnormalities. Scintigrams were performed in 12 patients in whom stress fractures could not be excluded by radiographs and clinical examination. Conservative treatment failed to relieve the symptoms. At follow‐up 34 months (range 6–85) after surgery, 95% of the men and 73% of the women were free of symptoms or improved compared with prior to surgery. Whereas 68% of the men were totally free of symptoms, the corresponding figure for the women was 36%. Ninety‐five percent of the men and 82% of the women returned to sport after surgery. Seventy‐four percent of the men and 54% of the women returned to an activity level similar to that prior to injury. We conclude that fasciotomy of the deep posterior compartment gives a good long‐term result in patients with medial tibial syndrome when conservative treatment fails. There was no significant difference betwee