Medial Tibial Stress Syndrome

Wikis > Orthopaedics > Leg Problems > Medial Tibial Stress Syndrome

Overuse inflammatory condition that is characterised by pain along the posterior medial crest of the tibia. Most common cause of exercise induced leg pain. Prevalence varies widely in studies (depends on diagnostic criteria) – from 4-60% of exercise related injury.

Overuse injury/training errors/biomechanical faults/unaccustomed exercise.
Females have 2x greater risk and a pronated foot has 1.7x greater risk .

Assumed to be an insertional fasciitis, periostitis and osteitis  stress reaction.
Bouche (2001) has proposed the ‘tibial fascia traction theory’, as it possibly involves the crural fascia – increased eccentric contraction of flexors  increased fascial tension insertion  fatigue failure – this is analogous to the pathology of insertional plantar fasciitis (therefore MTSS could be called ‘tibial fasciitis’)
Posterior tibial tendon is not involved . Stress reactions localised in bone on bone scans have shown in cadaver dissection to be more closely related to the insertion of the soleus muscle and its fascia than the posterior tibial muscle .

Tibial bending moment due to runner’s varus.

Clinical features:
Gradual onset; diffuse pain along posteromedial border of distal two thirds of tibia- generally decreases with warm up – progresses to pain being worse after activity and at rest; tender to palpation along posteromedial border; muscle testing normal; x-rays usually negative, but may have slight cortical hypertrophy; bone scans positive;
One legged hop test  produces pain after several minutes if MTSS, but sooner if stress fracture

Differential diagnosis – stress fracture; compartment syndrome

ICE; NSAID’s; activity modification (restriction of pain causing activity); pain and inflammation reduction – physical therapies; foot orthoses; transverse frictions; eccentric plyometric exercises important; calf muscle stretching;
Surgical – cauterisation or fasciotomy
Prevention – eliminate training errors; correction of biomechanical faults; improve flexibility

Kirby suggest orthoses with forefoot varus post to prevent tibial bending moment from runner’s varus.

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