Medial Tibial Stress Syndrome (Tibial Fasciitis)

2007 ◽  
Vol 97 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Richard T. Bouché ◽  
Cherie H. Johnson
Keyword(s):  
Strain Gauges ◽  
Overuse Injuries ◽  
Medial Tibial Stress Syndrome ◽  
Flexor Digitorum Longus ◽  
Posterior Tibial ◽  
Stress Syndrome ◽  
Fresh Cadaver ◽  
Flexor Digitorum ◽  
Linear Manner

Although medial tibial stress syndrome is one of the most common lower-extremity overuse injuries, its pathomechanics remain controversial. Two popular theories have been proposed to account for this condition: tibial bending and fascial traction. This article evaluates the role of fascial traction in medial tibial stress pathomechanics. We hypothesized that with contraction of the deep leg flexors tension would be imparted to the tibial fascial attachment at the medial tibial crest. We also speculated that circumferential straps would dampen tension directed to the medial tibial crest. The amount of strain present in the tibial fascia adjacent to its distal medial tibial crest insertion during loading of the leg was investigated as a descriptive laboratory pilot study using three fresh cadaver specimens. Strain in the distal tibial fascia was measured using strain gauges placed in the fascia at its medial tibial crest insertion. As tension on the posterior tibial, flexor digitorum longus, and soleus tendons increased, strain in the tibial fascia increased in a consistent linear manner (P < .0001). We conclude that fascial tension may play a role in the pathomechanics of medial tibial stress syndrome. The tenting effect of the posterior tibial, flexor digitorum longus, and soleus tendons caused by muscle contraction exerts a force on the distal tibial fascia that is directed to its tibial crest insertion. Circumferential straps provided no dampening effect on tension directed to the medial tibial crest. (J Am Podiatr Med Assoc 97(1): 31–36, 2007)

scholarly journals Medial Tibial Stress Syndrome: Muscles Located at the Site of Pain

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Ato Ampomah Brown
Keyword(s):  
Tibialis Posterior ◽  
Medial Tibial Stress Syndrome ◽  
Medical Sciences ◽  
Flexor Digitorum Longus ◽  
Cape Coast ◽  
Crural Fascia ◽  
Stress Syndrome ◽  
Flexor Digitorum ◽  
The Relationship

Objective. The purpose of this study was to examine the relationship between the location of the MTSS pain (posteromedial border of tibia) and the muscles that originate from that site.Method. The study was conducted in the Department of Anatomy of the School of Medical Sciences, University of Cape Coast, and involved the use of 22 cadaveric legs (9 paired and 4 unpaired) from 11 males and 2 females.Findings. The structures that were thus observed to attach directly to the posteromedial border of the tibia were the soleus, the flexor digitorum longus, and the deep crural fascia. The soleus and flexor digitorum longus muscles were observed to attach directly to the posteromedial border of the tibia. The tibialis posterior muscle had no attachment to this site.Conclusion. The findings of this study suggest that if traction is the cause of MTSS then soleus and the flexor digitorum muscles and not the tibialis posterior muscle are the likely cause of MTSS.

Bilateral Posterior Tibial Tendon and Flexor Digitorum Longus Dislocations

2016 ◽  
Vol 10 (2) ◽  
pp. 162-166
Author(s):  
Eric M. Padegimas ◽  
David M. Beck ◽  
David I. Pedowitz
Keyword(s):  
Physical Therapy ◽  
Suture Anchor ◽  
Plantar Flexion ◽  
Posterior Tibial Tendon ◽  
Flexor Digitorum Longus ◽  
Posterior Tibial ◽  
Left Ankle ◽  
The Right ◽  
Flexor Digitorum ◽  
Suture Anchor Repair

The authors present a case of a previously healthy and athletic 17-year-old female who presented with a 3.5-year history of medial left ankle pain after sustaining an inversion injury while playing basketball. Prior to presentation, she had failed prior immobilization and physical therapy for a presumed ankles sprain. Physical examination revealed a dislocated posterior tibial tendon (PTT) that was temporarily reducible, but would spontaneously dislocate immediately after reduction. She had pain and snapping of the PTT with resisted ankle plantar flexion and resisted inversion as well as 4/5 strength in ankle inversion. The diagnosis of dislocated PTT was confirmed on magnetic resonance imaging (MRI). The patient underwent suture anchor repair of the medial retinaculum of the left ankle. At the time of surgery both the PTT and flexor digitorum longus (FDL) were dislocated. Three months postoperatively, the patient represented with PTT dislocation of the right (nonoperative) ankle confirmed by MRI. After failure of immobilization, physical therapy, and oral anti-inflammatory medications, the patient underwent suture anchor repair of the medial retinaculum of the right ankle. At 6 months postoperatively, the patient has 5/5 strength inversion bilaterally, no subluxation of either PTT, and has returned to all activities without limitation. The authors present this unique case of bilateral PTT dislocation and concurrent PTT/FDL dislocation along with review of the literature for PTT dislocation. The authors highlight the common misdaiganosis of this injury and highlight the successful results of surgical intervention. Levels of Evidence: Level V: Case report

Dislocation of the Flexor Digitorum Longus and Posterior Tibial Tendons Without Fracture Dislocation of the Ankle: A Case Report

2007 ◽  
Vol 28 (11) ◽  
pp. 1187-1189 ◽  
Author(s):  
Rodrigo O.C. Aguiar ◽  
Marcus Vinicius G. Cabral ◽  
Bruno B. Moura ◽  
Edson Marchiori
Keyword(s):  
Case Report ◽  
Fracture Dislocation ◽  
Flexor Digitorum Longus ◽  
Posterior Tibial ◽  
Flexor Digitorum

Intermediate Term Follow-up of Calcaneal Osteotomy and Flexor Digitorum Longus Transfer for Treatment of Posterior Tibial Tendon Dysfunction

2002 ◽  
Vol 23 (12) ◽  
pp. 1107-1111 ◽  
Author(s):  
Amir H. Fayazi ◽  
Hoan-Vu Nguyen ◽  
Paul J. Juliano
Keyword(s):  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Flexor Digitorum Longus ◽  
Posterior Tibial Tendon Dysfunction ◽  
Posterior Tibial ◽  
Calcaneal Osteotomy ◽  
Effective Form ◽  
Flexor Digitorum ◽  
Shoe Wear

Twenty-three patients with stage II posterior tibial tendon dysfunction who had failed non-surgical therapy were treated with flexor digitorum longus transfer and calcaneal osteotomy. At latest follow-up averaging 35±7 months (range, 24 to 51 months), 22 patients (96%) were subjectively “better” or “much better.” No patient had difficulty with shoe wear; however, four patients (17%) required routine orthotic use consisting of a molded shoe insert. AOFAS scores were available on 21 patients and improved from a preoperative mean of 50±14 (range, 27 to 85) to a postoperative mean of 89±10 (range, 70 to 100). Our experience, at an intermediate date follow-up is that calcaneal osteotomy and flexor digitorum longus transfer is a safe and effective form of treatment for stage II posterior tibial tendon dysfunction.

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