Anterior Tibial Periostitis and Medial Tibial Stress Syndrome

Anterior Tibial Periostitis

A.k.a. Shin Splints

Shin Splints

An overuse injury of the shin area that leads to persistent dull anterior leg pain

Shin Splints

Associated with activities that involve excessive dorsiflexion of the foot

Tibia

larger and medial bone of the lower leg

Fibula

thinner, lateral bone of the lower leg, and supports leg stability

Tibialis Anterior

primary muscle affected that is responsible for dorsiflexion and inversion

Extensor Digitorum Longus

assists in extending the toes and dorsiflexion of the foot. Overactivity of this

muscle can add stress to the anterior tibial region.

Extensor Hallucis Longus

extends the big toe and also aids in dorsiflexion

Tibialis Anterior Tendon

runs along the top of the foot inserting on the medial side. Stress on this tendon

can irritate the periosteum

Interosseous Membrane

fibrous sheet that connects tibia and fibula, also helps in stabilizing lower leg

external trauma or injury to a bone and overuse

most common causes behind this tissue inflammation.

Acute

shorter term with less susceptibility

chronic

the longer term with more

underlying causes.

Grade 1 (Mild):

Severity levels: pain occurs only when doing physical activity. Minimal

swelling is seen around the area and tenderness upon touching.

Grade 2 (Moderate):

Severity levels: pain continues after physical activity. Swelling and

tenderness can worsen overtime and are seen with slight activity.

Grade 3 (Severe):

Severity levels: pain is constant and will hinder ADLs. Swelling and

tenderness are very obvious and can lead to chronic stage.

Medial Tibial Stress Syndrome

A repetitive stress injury characterized by pain along the inner edge of the

tibia

Medial Soleus

- originates from tibia and fibula and inserts into Achilles tendon

- plays a role in plantarflexion

Tibialis Posterior

- runs along the back and inner part of the tibia

- plays a role in inversion and arch support

Flexor Digitorum Longus

located in the posterior tibia and is responsible for flexing toes

Mild MTSS (Grade 1):

Types, Classifications, Stages, Phases:
pain occurs after physical activity, no noticeable swelling, and usually mild and resolves with proper rest.

Moderate MTSS (Grade 2):

Types, Classifications, Stages, Phases

pain occurs during and after physical activity,

mild tenderness can be felt, usually doesn’t interfere with ADLs

Severe MTSS (Grade 3):

Types, Classifications, Stages, Phases:

persistent pain occurs before, during, and after,

noticeable tenderness and mild swelling

Very Severe MTSS (Grade 4):

Types, Classifications, Stages, Phases:

constant intense pain which affects ADLs,

high risk of progression to stress fracture, immediate intervention is needed.

"one-leg hop test"

a functional test, that can be used to distinguish between

medial tibial stress syndrome and a stress fracture

Provocative test:

pain on resisted plantar flexion

“posterior fasciotomy”

common procedure performed. This may

include cauterization of the posteromedial ridge of the tibia.

NSAIDs and Acetaminophen

often used for analgesia.