Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Tibialis posterior tendonitisPosterior medial tibial periostitisMedial tibial stress syndromePosterior 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 ++ Pattern 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation +++ Description ++ Lower medial leg pain from overusePain is localized in the posterior medial aspects of the tibiaStress-reaction inflammation of the periosteal and musculotendinous fascial junctionsAttributed to muscles of the lower extremities being overloaded or by biomechanical irregularitieshiRecurring dull ache along the posterior medial aspect of the lower tibia +++ Essentials of Diagnosis ++ Diagnosis is usually made by clinical examinationPain increases with active plantar flexion and when the tibialis posterior muscle is stretched into dorsiflexionMuscle length and strength imbalances, especially a tight gastrocnemius-soleus muscle group +++ General Considerations ++ TendinopathyPeriostitisPeriosteal remodelingDysfunction of the tibialis posterior and soleus musclesResults from repeated activity without proper conditioning or allowing enough recovery time between activitiesPain with repetitive activity, when the involved musculotendinous unit is stretched +++ Demographics ++ Beginning runners with poor lower extremity muscle control; increased pronation +++ Signs and Symptoms ++ Tightness in gastrocnemius, soleus, and plantar musclesPain: mild to severe with weight-bearing activities and gaitDescribed as a dull ache to lower extremitiesPoint tenderness to tibia at posterior medial aspectPossible localized swellingMuscle guarding with passive movement +++ Functional Implications ++ Pain with standing or during activityInability of injured lower extremity to bear weightPain with closed chain ankle movements (i.e., driving) +++ Possible Contributing Causes ++ Impaired standing balanceExcessive pronationFlat feetBarefoot walkingRunning on uneven surfacesRunning in worn out shoes or shoes that do not fit properlyRunning/standing on a hard surface shoesLeg length inequalityCompensation from an injury on the opposite limbHistory of high/repetitive impact activitiesOvertrainingMuscle imbalance with ankle dorsiflexors and plantarflexorsTight or strong ankle plantarflexors overpowering the dorsiflexors +++ Differential Diagnosis ++ Fracture of the tibia or fibulaContusionGastrocnemius/soleus muscle strainDelayed onset muscle sorenessMedial tibial stress syndromeCellulitisNocturnal leg crampsReferred pain from sciatic nerve, spinal stenosis, or Baker’s cystDeep vein thrombosisSuperficial thrombophlebitisPeripheral arterial diseaseVenous insufficiencyMyofascial painFibromyalgiaPopliteal artery entrapmentSoft tissue tumor or bony metastasisOsteomyelitis +++ Imaging ++ X-ray for fracture, often limited viewTriple-phase bone scintigraphyComputed tomography (CT) scan for detailed imagingBone scan if stress fracture is suspectedMRI/MRAArteriograms +... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.