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I would be interested in your thoughts on tibial debridement for chronic medial tibial periostitis.
a collegue of mine has had medial tibial stress symdrome for the past 2 years - his sport in cricket , he's an all rounder, he has the biomechanics that tend to be prevelant with this condition, (although I am not his podiatrist so can only give basic information), he has tibial varum, forefoot supinatus, pronated stance and he has naturally thin lower legs.
his sport physcican and orthopod have recommended surgical tibial debridement followed by 4 weeks rest as the only treatment that is going to be of help long term so he can continue to play cricket. the surgeon said he had done 800+ with 90%success
a 2nd orthopaedic he consulted felt the surgery was risky with only a 60% chance of success.
so the question is - who to believe???
he is a physio so has been through the conservative treatment regimes of rest ice orthotics exercises oral antinflams etc
your thoughts would be appreciated
regards Denny

 

Hi Denny:
The number and % success seems rather high. Even if the surgeon has been in practice 20 years that's still 40/year.

Interesting that you mention his rather "thin lower legs" since this small diameter tibia is directly related to the incidence of Medial Tibial stress syndrome.
I assume they have ruled out stress fractures.

I don't think the success rate is 90%....maybe 60 on a good day. Also, he needs to consider his post op goals and what he himself considers success. If it is to participate in his given sport at a high level of competition, this might lower the success rate even more.

Steve

 

Thank you so much for your reply , Ishan's post op goals are to play cricket (club level not professional)- hopefully painfree, that's why he is considering surgery- he was told that MTSS over 4 months duration should always be treated surgically with debridement - not sure the theory behind this statement and can't say i've heard this before.
He had a bone scan today that showed hot spots corresponding to the pain areas, previous xrays were clear.
The most difficult part of the surgery appears to be the post op 4 weeks rest, which means he can't work which takes a bit of organisation and is obviously very costly.
again I appreciate you taking the time to respond and will post on the outcome