Kho et al (2021) described a group of symptoms that they called the tibialis anterior friction syndrome:
In clinical practice, the authors have encountered MRI studies referred for suspected tibial stress injury or stress fracture which demonstrate a constellation of soft tissue findings around the tibialis anterior tendon above the level of the superior extensor retinaculum. These findings and clinical presentation have not previously been described in the literature, to the best of the authors’ knowledge.
They described 5 cases, all athletes; 2 were runners and 3 were soccer players between the ages of 20 and 40 years.
Clinically they presented with an insidious onset of pain related to sporting activity with a suspicion of tibial stress injury.
The MRI findings of all five cases were:
…peritendinous fluid around the tibialis anterior tendon, proximal to the level of the sheath. This fluid was maximal at the level of the junction of the mid and distal thirds of the lower leg in all cases, with a mean cranio-caudal length of 13 cm (range 8–17 cm). Typically, the oedema and fluid extended down to just proximal to the ankle joint at the level of the superior extensor retinaculum. Despite the peritendinous changes, the tibialis anterior tendon itself was entirely normal on MRI in all cases, with no signal change, thickening nor focal disruption. There was no significant fluid within the tendon sheath more distally in any of the 5 cases. Invariably, oedema was seen around the peritendinous fluid. In all cases, there was oedema in the subcutaneous tissue and over the tibial periosteum. In all but one case, there was
also oedema near the distal musculotendinous junction and distal tibialis anterior muscle belly. However, no case demonstrated tibial bone marrow oedema, nor any focal abnormality of the cortex or medulla of the tibia, excluding a Friedricson grade 2–4 stress injury
The authors suggest that the MRI findings are consistent with a friction syndrome of tibialis anterior tendon, as it glides between the superior extensor retinaculum and the anterior tibia during ankle dorsiflexion and plantar flexion.
Treatment in all 5 cases was conservative with rest and physical therapy rehabilitation
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