Muscles at the site of pain for medial tibial stress syndrome

NewsBot · Mar 20, 2016

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Medial Tibial Stress Syndrome: Muscles Located at the Site of Pain
Ato Ampomah Brown
Scientifica Volume 2016 (2016), Article ID 7097489, 4 page (full text)

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.
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Admin2 · Mar 20, 2016

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NewsBot · Oct 2, 2019

Differences in muscle attachment proportion within the most common location of medial tibial stress syndrome in vivo
MasatoshiNakamuraabShuheiOhyaaTakafumiAokiaDaichiSuzukiaRyoHirabayashiabTakanoriKikumotoabEmiNakamuraabWataruItoabTomoyaTakabayashiabMutsuakiEdamaab
Orthopaedics & Traumatology: Surgery & Research; 28 September 2019

Introduction
The medial tibial stress syndrome is one of the most common causes of running-related injuries. The primary study objective was to observe the attachment proportion of flexor digitorum longus and soleus, at the most common location of medial tibial stress syndrome, using ultrasonography, on a large cohort of young males and females to evaluate for gender-based anatomical differences. The secondary objective of this study was to investigate the relationship between the anatomical features and medial tibial stress syndrome.

Methods
In this study, we observed whether or not flexor digitorum longus and/or soleus attached at the middle and distal thirds of the medial margin of the tibia (most common location of medial tibial stress syndrome) using ultrasonography. History of medial tibial stress syndrome was defined by inquiries.

Results
The Chi2 tests showed that the attachment proportion of the soleus in female participants was significantly higher than that observed in male participants. In addition, Chi2 testing showed that there were no significant differences between attachment proportion of soleus of legs with history of medial tibial stress syndrome and legs without history of medial tibial stress syndrome, in both male and female participants.

Conclusions
These results suggested that the anatomical features of flexor digitorum longus might be involved in medial tibial stress syndrome development, whereas the anatomical features of the soleus might not be involved in medial tibial stress syndrome development.
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NewsBot · Oct 25, 2021

Lower leg muscle structure and function are altered in long-distance runners with medial tibial stress syndrome: a case control study
Joshua Mattock, Julie R. Steele & Karen J. Mickle
Journal of Foot and Ankle Research volume 14, Article number: 47 (2021)

Background
Medial tibial stress syndrome (MTSS) is a common lower leg injury experienced by runners. Although numerous risk factors are reported in the literature, many are non-modifiable and management of the injury remains difficult. Lower leg muscle structure and function are modifiable characteristics that influence tibial loading during foot-ground contact. Therefore, this study aimed to determine whether long-distance runners with MTSS displayed differences in in vivo lower leg muscle structure and function than matched asymptomatic runners.

Methods
Lower leg structure was assessed using ultrasound and a measure of lower leg circumference to quantify muscle cross-sectional area, thickness and lean lower leg girth. Lower leg function was assessed using a hand-held dynamometer to quantify maximal voluntary isometric contraction strength and a single leg heel raise protocol was used to measure ankle plantar flexor endurance. Outcome variables were compared between the limbs of long-distance runners suffering MTSS (n = 20) and matched asymptomatic controls (n = 20). Means, standard deviations, 95 % confidence intervals, mean differences and Cohen’s d values were calculated for each variable for the MTSS symptomatic and control limbs.

Results
MTSS symptomatic limbs displayed a significantly smaller flexor hallucis longus cross-sectional area, a smaller soleus thickness but a larger lateral gastrocnemius thickness than the control limbs. However, there was no statistical difference in lean lower leg girth. Compared to the matched control limbs, MTSS symptomatic limbs displayed deficits in maximal voluntary isometric contraction strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles, and reduced ankle plantar flexor endurance capacity.

Conclusions
Differences in lower leg muscle structure and function likely render MTSS symptomatic individuals less able to withstand the negative tibial bending moment generated during midstance, potentially contributing to the development of MTSS. The clinical implications of these findings suggest that rehabilitation protocols for MTSS symptomatic individuals should aim to improve strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles along with ankle plantar flexor endurance. However, the cross-sectional study design prevents us determining whether between group differences were a cause or effect of MTSS. Therefore, future prospective studies are required to substantiate the study findings.
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NewsBot · Feb 13, 2023

Adolescent exercise-related lower leg pain musculotendinous characteristics
Alexandra F. DeJong Lempke et al
07 February 2023

Introduction
Exercise-related lower leg pain (ERLLP) is one of the most common injuries among adolescent runners, however there is limited information available on lower extremity musculotendinous characteristics in relationship to injury. Ultrasound imaging has previously been used to evaluate musculotendinous structures among adults with chronic lower limb injuries. Similar measurement approaches may be adopted to assess young runners with ERLLP.

Objective
To compare ultrasound-derived lower extremity musculotendinous thickness, echogenicity, and muscle fiber pennation angles between adolescent runners with and without ERLLP.

Design
Cross-sectional design.

Setting
Hospital-affiliated sports injury prevention center.

Participants
Twenty-eight adolescent runners with (N=14) and without ERLLP (N=14).

Interventions
Runners' patellar and Achilles tendons, and tibialis anterior, medial gastrocnemius, abductor hallicus, and flexor digitorum brevis muscles were assessed with ultrasound imaging using standardized procedures.

Main Outcome Measures
Separate repeated measures multivariate analyses of covariance (covariate: sex) were used to compare groups and limbs for mass-normalized musculotendinous thickness, musculotendinous echogenicity, and extrinsic ankle muscle fiber pennation angles.

Results
The adolescent ERLLP group had reduced average muscle size for all structures except the tibialis anterior compared to the uninjured group (mean difference [MD] range: -0.12- -0.49 mm/kg; p-range: 0.002-0.05), and reduced average medial gastrocnemius pennation angles on their case limb compared to their contralateral limb and the uninjured group (MD range: -3.7 - -6.4°; p<0.001). The ERLLP group additionally had reduced average patellar and Achilles tendon size (MD range: -0.14 - -0.15 mm/kg; p-range:0.02-0.03), and lower Achilles tendon echogenicity compared to uninjured counterparts (MD: -18; p=0.02).

Conclusions
Adolescent runners with ERLLP exhibited morphological musculotendinous changes that may occur either as a result of or as a contributing factor to pain and persistent dysfunction. Our findings highlight key targets for rehabilitation for young, injured runners, particularly intrinsic foot muscle strengthening.
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