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Medial Tibial Stress Syndrome: Muscles Located at the Site of Pain

by MASS4D® Prescription Orthotics February 01, 2017


The purpose of this study was to examine the relationship between the location of the Medial Tibial Stress Syndrome pain (posteromedial border of tibia) and the muscles that originate from that site.

Twenty-two cadaveric legs (9 paired and 4 unpaired) from 11 males and 2 females were used in the study.

The two heads of the gastrocnemius were transected and the muscle was reflected inferiorly to expose the underlying structures, the ligaments and tendons that attach to the medial aspect of the knee were removed, and the joint capsule was opened and the medial meniscus removed to expose the superior articular surface of the medial condyle of the tibia.

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The flexor retinaculum of the ankle and the deltoid (medial) ligament of the ankle were also removed to expose the tip of the medial malleolus.

The length of the tibia was then measured using anthropometric calipers from the middle of tibial plateau proximally to the tip of the medial malleolus distally.

The muscles and structures that attach to the posteromedial border of the tibia were noted.

All measurements were converted into percentages of the length of their respective tibia bones in order to make comparisons between bones.

In this study, the flexor digitorum longus (FDL) muscle was found to be attached to the medial part of posterior surface of tibia inferior to soleal line, the soleus muscle attached to the posterior surface of proximal part of fibula, soleal line, and the posteromedial aspect of the tibial, while the tibialis posterior (TP) muscle was found to attach to the posterior surface of interosseous membrane, the lateral aspect of the posterior surface of the tibia, and the medial part of the posterior fibular surface.

These findings 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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  1. Brown A. (2016) Medial Tibial Stress Syndrome: Muscles Located at the Site of Pain. Scientifica: March 2016, Vol. 2016, No. 2016, doi 10.1155/2016/7097489

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