Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Medial Tibia Stress Syndrome

SYMPTOMS

There is gradual onset of diffuse or localised exercise-induced pain at the posterior medial aspect of the mid and distal tibia. This condition is common during pre-season training. It typically occurs as a result of sudden changes in training habits, such as increase in intensity or amount of impact.

AETIOLOGY

This is a stress reaction of the tibia to excessive jumping or running exercises. The location of pain is around the origin of the flexor digitorum longus or posterior tibial muscles at the medial posterior part of the tibia. The anatomy can vary substantially between the left and right leg. Symptoms can also therefore vary correspondingly.

CLINICAL FINDINGS

There is tenderness on palpation over the posterior medial tibia along the the tibial border over the site of origin of the above-mentioned muscles. Pain can be provoked by repetitive jumping on the forefoot on hard ground.

INVESTIGATIONS

X-ray is normal. MRI may show sub-cortical oedema along the posterior medial tibia and can usually exclude a more localised stress fracture.

TREATMENT

This injury most often responds to conservative treatment including modification of training and stretching exercises over three months. There is seldom any indication of immobilisation or surgery but if symptoms persist for more than three months a fasciotomy, releasing the tibial fascia overlying the flexor muscles from the tibial border may be indicated.

REFERRALS

Refer to physiotherapist for planning of three months’ return programme back to full sport. Refer to orthopaedic surgeon if non-operative treatment fails.

EXERCISE PRESCRIPTION

Cycling and swimming and most other low-impact activities are good alternatives to keep up general fitness. Running on soft ground is usually acceptable.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Posterior chronic compartment syndrome; Shin splints (superficial periostitis-cortical micro-fractures); Medial
posterior tibia stress fracture (more localised pain and swelling, X-ray or MRI will differentiate).

PROGNOSIS

Excellent but symptoms can last for months.

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