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Condition/Disorder Synonyms


  • Tibialis posterior tendonitis

  • Posterior medial tibial periostitis

  • Medial tibial stress syndrome

  • Posterior medial tibial stress fracture


ICD-9-CM Code1


  • 844.9 Sprains and strains of unspecified site of knee and leg


ICD-10-CM Code2


  • S86.919A Strain of unspecified muscle(s) and tendon(s) at lower leg level, unspecified leg, initial encounter


Preferred Practice Pattern3


Key Features




  • Lower medial leg pain from overuse

  • Pain is localized in the posterior medial aspects of the tibia

  • Stress-reaction inflammation of the periosteal and musculotendinous fascial junctions

  • Attributed to muscles of the lower extremities being overloaded or by biomechanical irregularitieshi

  • Recurring dull ache along the posterior medial aspect of the lower tibia


Essentials of Diagnosis


  • Diagnosis is usually made by clinical examination

  • Pain increases with active plantar flexion and when the tibialis posterior muscle is stretched into dorsiflexion

  • Muscle length and strength imbalances, especially a tight gastrocnemius-soleus muscle group


General Considerations


  • Tendinopathy

  • Periostitis

  • Periosteal remodeling

  • Dysfunction of the tibialis posterior and soleus muscles

  • Results from repeated activity without proper conditioning or allowing enough recovery time between activities

  • Pain with repetitive activity, when the involved musculotendinous unit is stretched




  • Beginning runners with poor lower extremity muscle control; increased pronation


Clinical Findings


Signs and Symptoms


  • Tightness in gastrocnemius, soleus, and plantar muscles

  • Pain: mild to severe with weight-bearing activities and gait

  • Described as a dull ache to lower extremities

  • Point tenderness to tibia at posterior medial aspect

  • Possible localized swelling

  • Muscle guarding with passive movement


Functional Implications


  • Pain with standing or during activity

  • Inability of injured lower extremity to bear weight

  • Pain with closed chain ankle movements (i.e., driving)


Possible Contributing Causes


  • Impaired standing balance

  • Excessive pronation

  • Flat feet

  • Barefoot walking

  • Running on uneven surfaces

  • Running in worn out shoes or shoes that do not fit properly

  • Running/standing on a hard surface shoes

  • Leg length inequality

  • Compensation from an injury on the opposite limb

  • History of high/repetitive impact activities

  • Overtraining

  • Muscle imbalance with ankle dorsiflexors and plantarflexors

    • Tight or strong ankle plantarflexors overpowering the dorsiflexors


Differential Diagnosis


  • Fracture of the tibia or fibula

  • Contusion

  • Gastrocnemius/soleus muscle strain

  • Delayed onset muscle soreness

  • Medial tibial stress syndrome

  • Cellulitis

  • Nocturnal leg cramps

  • Referred pain from sciatic nerve, spinal stenosis, or Baker's cyst

  • Deep vein thrombosis

  • Superficial thrombophlebitis

  • Peripheral arterial disease

  • Venous insufficiency

  • Myofascial pain

  • Fibromyalgia

  • Popliteal artery entrapment

  • Soft tissue tumor or bony metastasis

  • Osteomyelitis


Means ...

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