MTSS

Question 1

structures and possible diagnoses you would consider:

Answer 1

• Tibia, tib post FHL, FDL ,soleus, nerve
  Dx: medial tibial stress syndrome (worst in morning and after exercise)
• Tendonitis- periosteum becoming inflammed
  Ddx: chronic exertional compartment syndrome

Question 2

describe any other tests you would now consider to better determine your diagnosis.

Answer 2

• PALPATION: evaluate pain distribution, warmth, swelling, pitting oedema
  o Tibia: focal pain indicates stress fracture, diffuse pain over posterior medial border of tibia indicates medial tibial stress syndrome
• Active movements: assess motor function and range of motion
  o PF/ DF
  o INV/EV
• Passive movements: assess true joint ROM- may exacerbate pain in compartment syndromes
  o PF, DF, INV/EV
• Resisted movements- assess motor function, may exacerbate pain in muscle strains and tendinopathy
  o PF/ DF
  o INV/EV
• Functional tests
  o Hopping
  o Jumping
  o Running-

Question 3

What factors may be contributing to the problem

Answer 3

• Limited ankle joint ROM
  o Restricted ankle DF (ankle equinas) and inc tendency for excessive pronation – more force through tib post, peroneal longus
• High tibial influence- tendons at end range
• Reduced hip IR and ABD
• Tibial influence- causing inverted pos in neutral
• Exercise regime- not loading adequately
• Footwear

Question 4

How do you think this is affecting other biomechanical factors? Consider tissue stress theory, Supination resistance, and the presenting gait.

Answer 4

• Pts with excessive pronation led to soleus, tib post, FHL FDL to contract eccentrically harder and longer to resist pronation after heel strike- lack of activation of windlass
• On toe off, these muscles must contract concentrically over a greater length to complete transition to a supinated foot creating a rigid lever for push off
• With repetitive excessive pronation, the tibia and fibula are exposed to repetitive rotational (torque) stresses
• Femoral loading force on tibia  inc tibial valgus bending moment causes inc medial tibial cortical tensions stress  (GRF) varus ffoot footstrike results in eccentric tibial loading and inc tibial valgus bending momemtn
• These stresses are transferred across the fibula, tibia and proximal and distal tibiofibular
• Posterior tibial tendon weakness can contribute to foot pronation

Question 5

Short term

Answer 5

• Rest
• Activity modification- less repetition and WB
• Load tendons- calf raises- 3 x 8 reps
• Isometric strengthening (tendon)
• Footwear education- landing pos inv- tib ant- long pronation lever arm
  o Neutral shoe, good stability
• Stretching
• Heel lift- short term

Question 6

long term

Answer 6

• Orthotics
  minimal arch fill needs rearfoot control
  Heel post- adds stability
  Medial flange- stop from rotating over edge