Midfoot kinematics and muscle activation in patients with medial tibial stress syndrome

NewsBot · Apr 11, 2011

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Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome.
Rathleff MS, Samani A, Olesen CG, Kersting UG, Madeleine P
J Electromyogr Kinesiol. 2011 Apr 5;

Medial tibial stress syndrome is a common overuse injury characterized by pain located on the medial side of the lower leg during weight bearing activities such as gait. The purpose of this study was to apply linear and nonlinear methods to compare the structure of variability of midfoot kinematics and surface electromyographic (SEMG) signals between patients with medial tibial stress syndrome and healthy controls during gait. Fourteen patients diagnosed with medial tibial stress syndrome and 11 healthy controls were included from an orthopaedic clinic. SEMG from tibialis anterior and the soleus muscles as well as midfoot kinematics were recorded during 20 consecutive gait cycles. Permuted sample entropy and permutation entropy were used as a measure of complexity from SEMG signals and kinematics. SEMG signals in patients with medial tibial stress syndrome were characterized by higher structural complexity compared with healthy controls (p<0.001) while it was the opposite for the midfoot kinematics (p=0.01). Assessing the complexity of midfoot kinematics and SEMG activation pattern enabled a precise characterization of gait in patients with medial tibial stress syndrome. The reported inverse relationship in foot kinematics and SEMG complexity most likely point towards separated control processes governing gait variability.
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Admin2 · Apr 11, 2011

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NewsBot · Jun 1, 2012

Dynamic Midfoot Kinematics in Subjects with Medial Tibial Stress Syndrome
Michael S. Rathleff, Luke A. Kelly, Finn B. Christensen, Ole H. Simonsen, Søren Kaalund, Uffe Laessoe
J Am Podiatr Med Assoc 102(3): 205–212, 2012

Background: Medial tibial stress syndrome (MTSS) is a common diagnosis. Several studies have demonstrated that excessive static navicular drop (ND) is related to the diagnosis. However, no studies have yet investigated ND and the velocity of ND during dynamic conditions. The aim of this study was to evaluate ND characteristics in patients with MTSS in dynamic and static conditions.

Methods: In a case-control study, 14 patients diagnosed as having MTSS were included from an orthopedic outpatient clinic. A control group consisting of 14 healthy participants was matched regarding age, sex, and typical sporting activity. Navicular drop was evaluated during treadmill walking by a two-dimensional video analysis. Static foot posture, static ND, dynamic ND (dND), and velocity of dND were compared.

Results: The two groups were comparable in relation to age, sex, height, weight, and foot size. No significant difference was found in static foot posture. Static ND showed a mean difference of 1.7 mm between the groups (P = .08). During treadmill walking, patients with MTSS had, on average, a 1.5-mm-larger dND (P =.004) and a 2.4-mm/sec-larger mean velocity of dND (P = .03).

Conclusions: Patients with MTSS display a larger ND and a higher ND velocity during treadmill walking. Increased ND velocity may be important to this condition. Future studies should include velocity of dND to investigate the mechanisms of dND in relation to overuse injuries.
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NewsBot · May 17, 2019

Ankle Joint Kinetics in Runners with Medial Tibial
Stress Syndrome
James Becker et al
ACSM ANNUAL MEETING
May 28 – June 1, 2019 – Orlando, Florida

Medial tibial stress syndrome (MTSS) is a common overuse running injury. While
numerous studies have reported abnormal ankle kinematics in runners with MTSS,
to date, no studies have evaluated ankle kinetics in this population. PURPOSE: To
compare ankle kinetics in runners with and without MTSS. METHODS: Participants
included eight runners with MTSS (sex: 7M/1F; age: 35 ± 11.3 years) and eight
matched controls (CON; sex: 7M/1F; age: 35 ± 8.7 years). Kinematics and ground
reaction forces were recorded while participants ran overground. Sagittal plane kinetics
were calculated about an axis connecting the malleoli while frontal plane kinetics were
calculated about an axis approximating the 23° medially deviated and 42° inclined
orientation of the subtalar joint. Joint work was calculated by integrating the joint
power curves. Paired t-tests were used to compare peak moments, powers, and work
between MTSS and CON groups. RESULTS: Neither peak plantar flexor (MTSS:
2.14 ± 0.53, CON: 2.24 ± 0.57 Nm/kg) nor peak invertor (MTSS: 1.04 ± 0.34, CON:
1.16 ± 0.32 Nm/kg) moments were different between groups (p = .720, p = .472,
respectively). There were no differences in sagittal plane powers or work between
groups. In the frontal plane, the MTSS group demonstrated lower peak positive power
(MTSS: 1.97 ± 0.38, CON: 3.05 ± 1.12 W/kg, p = .021), and performed less negative
(MTSS: -0.09 ± 0.02, CON: -0.16 ± 0.07 J/kg, p = .032), positive (MTSS: 0.14 ± 0.03,
CON: 0.22 ± 0.07 J/kg, p = .039), and total (MTSS: 0.23 ± 0.06, CON: 0.37 ± 0.15
J/kg, p = .032) work. CONCLUSIONS: Compared to healthy individuals, runners
with MTSS are not able to generate as much energy to invert their foot during late
stance. This may explain why previous studies have observed runners with MTSS have
prolonged rearfoot eversion during stance.
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NewsBot · Jun 24, 2020

Rearfoot and Tibial Motion during Gait Associated with Medial
Tibial Stress Syndrome: A Systematic Review
Hyung-Pil Jun et al
Korean Society of Exercise Physiology

PURPOSE: The purpose of this study was to confirm the kinematic characteristics of overuse leg injuries during gait through a systematic review.
METHODS: Electronic databases from 1960 to 2018 were used to search studies. Physiotherapy Evidence Database Scale was used for
quality of studies. Effect sizes (ES) of between-groups and its 95% confidence intervals were calculated.
RESULTS: Seven studies were selected for review. The average Physiotherapy Evidence Database Scale score was 4.3 of 10-point scale.
The ES for maximum rearfoot eversion from 5 studies ranged from -0.34 to 0.67 with 3 of 5 studies statistically significant. The ES of
eversion excursion from 4 studies ranged from -0.24 to 2.37 and 3 of 4 studies showed statistically significant. The ES of maximum
eversion velocity ranged from 0.29 to 0.38 from all of 2 studies. With abduction, the ES for abduction excursion ranged from -0.04 to
0.35, and 2 of 3 studies revealed statistically significant. The ES of maximum abduction velocity showed statistically significant with the
ES of 0.23 and 0.61. However, maximum abduction from 3 studies showed non-significant with ES ranges from 0.00 to 0.62.
CONCLUSIONS: The rearfoot motion (eversion) associates with overuse leg injuries during gait more than tibial motion (internal rotation).
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NewsBot · Sep 29, 2020

Comparison of Transverse Plane Tibial and Frontal Plane Rearfoot Motion and Movement Coordination Between Runners With Medial Tibial Stress Syndrome and Healthy Controls
Journal of Applied Biomechanics
Ben Langley, Nick Knight, and Stewart C. Morrison

Medial tibial stress syndrome (MTSS) is a common running-related injury. Alterations in movement patterns and movement coordination patterns have been linked to the development of overuse injuries. The aim of this study was to compare transverse plane tibial and frontal plane rearfoot motion and the coordination of these movements between runners with MTSS and healthy controls. A total of 10 recreational runners with MTSS and 10 healthy controls ran at 11 km/h on a treadmill. A 3-camera motion analysis system operating at 200 Hz was used to calculate tibia and rearfoot motion. Stance phase motion patterns were compared between groups using multivariate analysis, specifically, Hotelling T2 test with statistical parametric mapping. A modified vector coding technique was used to classify the coordination of transverse plane tibial and frontal plane rearfoot motion. The frequency of each coordination pattern displayed by each group was compared using independent samples t tests. Individuals with MTSS displayed significantly (P = .037, d = 1.00) more antiphase coordination (tibial internal rotation with rearfoot inversion) despite no significant (P > .05) differences in stance phase kinematics. The increased antiphase movement may increase the torsional stress placed upon the medial aspect of the tibia, contributing to the development of MTSS.
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NewsBot · Nov 10, 2021

A Case Study Comparison of Lower Extremity Kinematics in Medial Tibial Stress Syndrome
Hernandez, Amanda; VanOosbree, Patricia; and Wiegand, Kristyne
International Journal of Exercise Science: Conference Proceedings: Vol. 14 : Iss. 1 , Article 79

Medial tibial stress syndrome (MTSS) affects up to 35% of runners. Chronic MTSS can negatively affect performance or lead to a cessation of activity. Though biomechanical variables such as hip internal rotation, tibial abduction, and rearfoot eversion are considered potential risk factors for MTSS, the research is equivocal. PURPOSE: Therefore, the purpose of this case analysis is to compare lower extremity kinematics of a D3 middle-distance runner with chronic MTSS vs. a matched uninjured runner. METHODS: This case study consists of two female middle-distance runners. Participant one (19 y.o., 1.73 m, 70.3 kg) experienced intermittent MTSS for 4 years. Participant two (20 y.o., 1.70 m, 70 kg) had no history of MTSS. Participants reported to the laboratory for one day of testing. Forty-one retroreflective markers were adhered to the hip, legs, and feet using a modified 6-degrees of freedom model. Participants ran on a treadmill at 3.58 m/s in a lab while eight 3D motion capture cameras collected kinematic data. Marker trajectories were labeled, gap-filled, and smoothed using a low-pass, zero lag Butterworth filter at 10 Hz. Hip, knee, and ankle angles were calculated during stance phase, defined as heel strike to toe-off and identified using a kinematic-only method. Variables of interest include right-limb ROM and peak values of transverse hip kinematics and frontal knee and ankle kinematics. RESULTS: The injured participant had less transverse hip ROM (UI: 15.1°, I: 9.6°), and less peak internal rotation (UI: 0.4°, I: 3.0°). At the knee, the injured participant had greater frontal ROM (UI: 6.0°, I: 8.2°) but less peak tibial abduction (UI: 6.6°, I: 5.8°). At the rearfoot, the injured participant had less frontal ROM (UI: 14.5°, I: 6.3°) and less peak eversion (UI: 23.6°, I: 15.2°). CONCLUSION: These differences provide additional information regarding potential MTSS risk factors. The athlete with MTSS exhibited less hip internal rotation, which has been indicated as a potential risk factor for MTSS. Other potential factors, including hip abduction and rearfoot eversion, were limited. These results support findings that weak hip stabilizers may contribute to MTSS. Further research should be conducted to better identify biomechanical risk factors for the development of training and rehabilitation programs.
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NewsBot · Feb 2, 2022

Difference in the foot intersegmental coordination pattern between female lacrosse players with and without a history of medial Tibial stress syndrome; a cross-sectional study
Hiroshi Akuzawa, Tomoki Oshikawa, Koji Nakamura, Ren Kubota, Norifumi Takaki, Naoto Matsunaga & Koji Kaneoka
Journal of Foot and Ankle Research volume 15, Article number: 8 (2022)

Background
Medial tibial stress syndrome is a common sports related injury. Altered foot kinematics can be a risk factor for the injury. Since foot segments can move independently, intersegment coordination is important for proper foot function. This study aimed to compare the foot intersegmental coordination pattern and single segment kinematics between female lacrosse players with and without a history of medial tibial stress syndrome during drop jump.

Methods
Twelve players with a medial tibial stress syndrome history and 12 players with no history were enrolled. Foot kinematics, including angle at landing and peak angle and excursion at the rearfoot, midfoot, and forefoot during single-leg drop jumps were analysed. Each segment motion data from landing to leaping was time-scaled to 100% to analyse the intersegmental coordination with a modified vector coding technique. Instant intersegmental coordination of every 1% was classified into four patterns (in-phase, two segments rotate in the same direction with similar amplitudes; anti-phase, two segments rotate in opposite directions; proximal phase, proximal segment dominantly rotates in the same direction compared to the distal segment; and distal phase, distal segment dominantly rotates in the same direction compared to the proximal segment). The percentage of intersegmental coordination pattern and kinematics in each segment were compared between the groups using the Student’s t test.

Results
Groups with a history of medial stress syndrome showed a significantly higher percentage of proximal phase between the rearfoot and midfoot in the sagittal (Mean ± SD; history, 52.2 ± 17.9%, no history, 29.3 ± 16.7%; p = 0.004) and coronal planes (history, 40.3 ± 22.0%, no history, 15.9 ± 9.1%; p = 0.004). Dorsiflexion excursion (history, 34.5 ± 4.5°, no history, 29.6 ± 2.1°; p = 0.003) were significantly larger in a history of medial tibial stress syndrome group compared to no history group.

Conclusions
Rearfoot dominant motion pattern relative to the midfoot may be related to medial tibial stress syndrome. Intersegmental coordination analysis may be useful for detecting abnormal foot coordination patterns. Also, stabilization for the rearfoot may be required rather than the midfoot for intervention
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