The Piedmont District has traditionally been strong in men's basketball, with Martinsville High School having won multiple VHSL Championships. Martinsville High School has won more men's basketball State Championships (a total of 15) than any other school in the Commonwealth of Virginia.
Martinsville High School has won more state championships in the Piedmont District than any other team. Championships include twelve men's basketball state championships, one women's basketball state championship, two football state championships, and two golf state championships.
Tunstall High School has won four state championships in baseball and one state title in wrestling.