Medial tibial syndrome

Findings

This is impact initiated, but the patient may have good biomechanical function with large calves. The palpable tenderness extends over several centimeters along almost all the medial border of the tibia, and there may be a stress fracture present as well. There may also be anatomical or functional overpronation at the feet.

Cause

This is not well understood, but, fortunately, it is not that common. It may be the same mechanism as for a stress fracture and possibly reflects a gradual adaptation to the loads. However, the loads are just too high, causing periosteal stress either from the attachments of fascia of the posterior compartment or from the elongated muscle enthesitis of the posterior tibialis, which in turn cases fibrous thickening.

Treatment

a)      With mainly the blood-phase positive, or only muscle oedema, try a fascial split.

b)      With mainly the bone-phase positive or mainly bony oedema, try tibial drilling.

c)      Like all overload problems, a reduction in loads, followed by incremental loading when pain-free, can be successful, but takes time for recovery.

d)     Correct overpronation with orthotics for the feet, and increase core stability to prevent pelvic rotation and functional valgus at the knee.

Sports

Running or dancing, but also other sports where running is used for training.

This problem is often difficult to handle as most athletes are too impatient to return to full activities. The problem takes several months to heal under a conservative regimen, so patients proceed to surgery, which can also have quite a delayed recovery time.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English