Aetiology, imaging and treatment of medial tibial stress syndrome. [free Phd thesis]
Medial tibial stress syndrome (MTSS) is defined as “pain along the posteromedial border of the tibia that occurs during exercise, excluding pain from ischemic origin or signs of stress fractures”.
The incidence of MTSS is reported as being between 4 and 35% in military personnel and athletes. Most probably it is caused by overloaded adaptation of the tibial cortex and not to periostitis as a result of traction, since histological studies fail to provide evidence. Evidence for overloaded adaptation of the cortex is found in studies describing MTSS findings on bone-scan, MRI, high resolution CT-scan and dual energy x-ray absorptiometry. The diagnosis is made clinically, although only one study has been conducted about physical examination. Additional imaging such as bone scan, CT-scan and MRI-scan is being of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution.
Excessive pronation of the foot while standing and female gender were found to be intrinsic risk factors in multiple prospective studies. Other prospectively found intrinsic risk factors such as body mass index, greater internal and external ranges of hip motion and calf girth were derived from solitary studies. No extrinsic risk factors were identified. The treatment of MTSS has been studied poorly, since only two studies were conducted. In these studies rest is equal to any intervention. The use of a neoprene or semi-rigid inlay may help prevent MTSS, since two large prospective studies provide evidence for this.
Although MTSS is one of the most common causes of leg complaints, in the past decades few studies have looked at MTSS. This thesis aimed at studying the aetiology, imaging and treatment of MTSS. > from Maarten Hendrik Moen (2012). All rights reserved to Maarten Moen and University Utrecht.
The free full text PhD. thesis (167 pages) can be downloaded here.