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  • Tibialis posterior tendonitis
  • Posterior medial tibial periostitis
  • Medial tibial stress syndrome
  • Posterior medial tibial stress fracture

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

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


  • 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

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


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