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Medial Tibial Stress Syndrome (Tibial Fasciitis)

A Proposed Pathomechanical Model Involving Fascial Traction

Richard T. Bouché, DPM ^*  and Cherie H. Johnson, DPM  

^* The Sports Medicine Clinic, Seattle, WA.
Division of Podiatric Surgery, Department of Orthopedics, Swedish Medical Center, Seattle, WA.
Ankle & Foot Clinic of Everett, Everett, WA.

Corresponding author: Richard T. Bouché, DPM, The Sports Medicine Clinic, 10330 Meridian Ave N, Ste 300, Seattle, WA 98133.

Abstract

Although medial tibial stress syndrome is one of the most common lower-extremity overuse injuries, its pathomechanics remain controversial. Two popular theories have been proposed to account for this condition: tibial bending and fascial traction. This article evaluates the role of fascial traction in medial tibial stress pathomechanics. We hypothesized that with contraction of the deep leg flexors tension would be imparted to the tibial fascial attachment at the medial tibial crest. We also speculated that circumferential straps would dampen tension directed to the medial tibial crest. The amount of strain present in the tibial fascia adjacent to its distal medial tibial crest insertion during loading of the leg was investigated as a descriptive laboratory pilot study using three fresh cadaver specimens. Strain in the distal tibial fascia was measured using strain gauges placed in the fascia at its medial tibial crest insertion. As tension on the posterior tibial, flexor digitorum longus, and soleus tendons increased, strain in the tibial fascia increased in a consistent linear manner (P < .0001). We conclude that fascial tension may play a role in the pathomechanics of medial tibial stress syndrome. The tenting effect of the posterior tibial, flexor digitorum longus, and soleus tendons caused by muscle contraction exerts a force on the distal tibial fascia that is directed to its tibial crest insertion. Circumferential straps provided no dampening effect on tension directed to the medial tibial crest. (J Am Podiatr Med Assoc 97(1): 31–36, 2007)