Medial Tibial Stress Injuries

Medial Tibial Stress injuries refer to overuse injuries commonly found in athletes and military personnel who experience pain along the posteromedial border of the tibia over a length that is either equal to or more than 5cm.

With a lack of consensus on the pathomechanism of these injuries, it is essential to evaluate the risk factors that increase the predisposition of an individual to these kinds of injuries in order to develop successful preventative measures.

These were investigated in detail by Karrie L. Hamstra-Wright, of the Department of Kinesiology and Nutrition at the University of Illinois, in her review of the risk factors for medial tibial stress syndrome in physically active individuals.

The factors listed out include increased body mass index, navicular drop, plantar flexion and hip external rotation – it is important to note here that an increased navicular drop is associated with lowered arch height, which is responsible for diminished tibial internal rotation and shock absorption especially while running.

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The author suggests that since navicular drop is related to fatigue of the foot intrinsic muscles, foot and arch exercises can be used to increase the rigidity of the arch and normalise navicular drop and tibial internal rotation in the process.

Dr Kevin Kirby, from the California School of Podiatric Medicine, recommends orthotics that are customised to shift ground reaction forces towards the medial aspect of the plantar foot and to gradually reduce the abnormal valgus bending moments on the tibia that cause medial tibial stress syndrome.

This medial shift in ground reaction forces will cause running loads to be aligned through the tibial long axis in order to decrease the bending stress on the medial tibial border.

Such highly customised foot orthotics will also help in reducing subtalar joint pronation moments to decrease the tensile force from the medial tibial muscles and fascia that can lead to pain along the posteromedial border of the tibia.

Imbalances caused by weakened intrinsic foot muscles can eventually cause extrinsic muscles such as the extensor hallucis longus, flexor digitorum longus, extensor digitorum longus and flexor hallucis longus to work overtime in order to overcome these imbalances.

This leads to hyperextension of the metatarsophalangeal joints and flexion of the interphalangeal joints which ultimately exaggerate the longitudinal arch of the foot via the windlass mechanism.

Contrary to the common misconception that orthotics weaken the intrinsic muscles, the augmented calibration process at MASS4D® ensures that the resultant orthotic provides the correct balance of a resistant force to allow optimal muscle function and to add strength to the intrinsic muscles for a speedy recovery and help the individual return to athletic activities.

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References:

1. Hamstra-Wright, K. L., Bliven, K. C. H., Bay, C. (2015) Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. British Journal of Sports Medicine: May 2015, Vol. 49, pp. 362-369. doi:10.1136/bjsports-2014-093462
2. Kirby, K. A. (2010) Current Concepts In Treating Medial Tibial Stress Syndrome. Podiatry Today: April 2010, Vol. 23, No. 4. Retrieved from: http://www.podiatrytoday.com/

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