Brief Outline of Tibia Stress Fracture

Tibial Stress Fracture

Repetitive impact activities, such as running and jumping, can cause small cracks in the bone called stress fractures. These most often occur in the weight bearing bone, the tibia, of the lower leg. Athletes with lower bone density, due to dietary issues or genetic predisposition, are more susceptible, as are athletes who train on hard surfaces at increased distance and duration. Women are more susceptible to this injury than men due to bone density deficiency conditions such as irregular or absent menstrual cycles, eating disorders or osteoporosis.

Anatomy and physiology

The tibia (shin bone) is the larger and more medial of the bones in the lower leg. At the proximal end, the medial and lateral condyles articulate with the distal end of the femur to form the knee joint. The tibia tuberosity is a roughened area on the anterior surface of the tibia. The tibia is the weight bearing bone of the lower leg and therefore takes a large amount of the force of impact during running and jumping activities. This force is transferred up the length of the bone. Bones are constantly repairing and rebuilding, leading to the robbing of calcium from one area of the bone to build another, causing a weak area. When the impact is transferred up the shaft and encounters a weak area, due to either calcium deficiency or a prior stress fracture, the bone will crack slightly. Overtime, this leads to a more serious crack or fracture. Fatigued muscles also contribute to the possibility of stress fractures. The muscles are meant to take some of the shock away from the bones but a fatigued muscle is a poor shock absorber.

Cause of Stress Fracture

Repetitive stress on the bone through impact activities such as running or jumping. Low bone density. Muscle fatigue leading to lower shock absorption by the muscles.

Signs and symptoms

Pain with weight bearing, worsens with activity and diminishes with rest. Pain is most severe at the early stage of activity, subsiding in the middle and returning at the end. Point tenderness and some swelling possible.

Complications if left unattended

If left stress fracture unattended, a stress fracture can become a complete fracture and lead to complications such as bleeding and nerve compromise. The pain from an untreated stress fracture may lead to a complete cessation of activity and further injury to surrounding tissues.

Treatment

  • Anti-inflammatory medication.
  • Shockwave therapy
  • Seek medical help if any instability is noted in the lower leg, or inability to bear weight.

Rehabilitation and treatment

During the recovery phase, it is important to maintain fitness levels by using low or non-impact activities such as swimming or biking. Strengthening the muscles of the lower leg will help add extra shock absorption. Warming-up properly and using cross training techniques to limit the impact of the bone will help prevent stress fractures.

Long-term prognosis

Stress fractures generally heal completely with rest. Returning to activity too soon may cause a recurrence. Very rarely surgical intervention may be needed to strengthen the bone at the fracture site.

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Joint Pain

Brief Outline of Medial Tibial Pain Syndrome – Shin Splints

Shin Splints

Shin splints are a common complaint of runners and other athletes who have just taken up running. Shin splints are actually a term used to cover all pain in the anterior shin area. There are several possible causes. Medial tibial pain syndrome, the most common cause of shin pain, refers to pain felt over the shin bone from irritation of the tendons that cover the shin and their attachment to the bones. Changes in duration, frequency or intensity of running can lead to this condition.

Anatomy and physiology

The tibialis anterior muscle originates from the lateral condyle of the tibia, and inserts into the medial and plantar surfaces of the medial cuneiform bone. Tibialis anterior is responsible for dorsiflexing and inverting the foot and is used frequently during running to toe up with each step. When the muscle and tendon becomes inflamed and irritated through overuse or improper form, it will cause pain in the front of the shin. Repetitive pounding on the lower leg, such as with running, can also lead to pain in the shin.

Cause of Shin Splints

Repetitive stress on the tibialis anterior muscle leading to inflammation. Repetitive pounding force on the tibia, as with running and jumping.

Signs and symptoms

Dull, aching pain over the inside of the tibia. Pain is worse with activity. Tenderness over the inner side of the tibia with possible slight swelling.

Complications if left Shin Splints unattended

If left unattended, shin splints can cause extreme pain and cause cessation of running activities. The inflammation can lead to other injuries, including compartment syndrome.

Treatment

Rehabilitation and prevention

It is important to use low impact activities, such as swimming or cycling, to maintain conditioning levels while recovering. Stretching of the tibialis anterior muscle will help with recovery. To prevent this condition from developing, try alternating high impact activity days with lower impact days. It is also important to strengthen the muscles of the lower leg to help absorb the shock of impact activities.

Long-term prognosis

Medial tibial pain syndrome can be effectively treated with no long-term effects. Only in rare cases does the condition fail to respond to rest and rehabilitation, leading to chronic inflammation and pain. Surgery may be required in those rare cases.

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Brief Outline of Tibiofibular Joint Dislocation

The tibiofibular joint is the point where the tibia and fibula of the lower leg connect. This junction is at the inferior surface of the lateral epicondyle of the tibia, just below the knee joint. The tibiofibular joint only allows for very limited movement between the two bones. A tibiofibular joint dislocation is most commonly caused by a high impact injury, such as a fall onto a bent knee with the foot pointing inward (inverted).

Cause of Tibiofibular Joint Dislocation

Impact to the knee or lower leg. Twisting of the knee.

Signs and Symptoms of Tibiofibular Joint Dislocation

Pain and swelling around the lateral epicondyle. Pain on weight bearing. Pain when bending or straightening the knee or ankle. In some cases there is a visible deformity at the joint.

Complications If Left Tibiofibular Joint Dislocation Unattended

Dislocation of the tibiofibular joint causes tearing of the ligaments that hold the joint together. This results in the knee joint being considerably more prone to successive dislocations and other injuries.

Treatment to Tibiofibular Joint Dislocation

Ice and Rest. Seek Medical Help Immediately.

Rehabiliation and Prevention for Tibiofibular Joint Dislocation

During rehabilitation, activities that do not aggravate the injury should be sought, such as swimming or cycling instead of weight-bearing activities like running. Strengthening the muscles around the knee will help to provide support. A knee brace may also be used to provide extra support when initially returning to activity.

Long-term Prognosis and Surgery for Tibiofibular Joint Dislocation

For relatively minor dislocations a closed reduction is used where the bones are placed back in line using manual manipulation, which does not require any incision or opening of the joint. Where the dislocation is quite severe, surgery is usually required to fix or attach the bones back together.

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Brief Outline of Fractures (Tibia, Fibula)

Most human bones have outer shells of cortical bone, which means that the porosity is low, with cancellous bone underneath (high porosity). The cortical bone means that the structure is stiffer and capable of withstanding great stress. When the outer shell is cracked it is called a fracture. The bone may be either partially fractured or completely broken.

Anatomy and Physiology of Fractures (Tibia, Fibula)

The tibia (shin bone) is the larger and more medial of the bones in the lower leg. At the proximal end the medial and lateral condyles articulate with the distal end of the femur to form the knee joint. The tibial tuberosity is a roughened area on the anterior surface of the tibia. The fibula lies lateral and parallel to the tibia and is thin and sticklike. The fibula is not a weight bearing bone and plays no part in the knee joint, the tibia i the only weight bearing bone of the lower leg. Both bones meet at the ankle. Although either bone can be fractured alone, they are most commonly fractured together. Most fractures involve the proximal (near the knee), or distal (near the ankle) ends of the bone. Due to the thin covering of skin and other tissue over the tibia, these fractures are often open fractures, meaning the broken bone ends break the skin.


TibiaFibulaFracture

 

Cause of Fractures (Tibia, Fibula)

Direct force (impact) to the bones along the shaft or extreme loading of the bone, such as with a landing from a high fall. Rotational or indirect forces on the bones, e.g. tackle in football. Twisting, especially when the bone is under a load or when the foot is fixed.

Signs and Symptoms (Tibia, Fibula)

Pain, inability to walk or bear weight, and often inability to move the leg. Deformity may be present at the fracture site, or the fracture may be open. Swelling and tenderness.

Complications If Left Tibia / Fibula Fractures Unattended

Instability in the lower leg is one long-term complication of an untreated fracture. Blood vessel damage from a fracture can lead to internal bleeding and swelling as well as circulation problems for the foot. Nerve involvement can lead to serious problems such as drop foot or a loss of sensation in the lower leg and foot.

Immediate Treatment for Tibia / Fibula Fractures

Immobilise the leg. Control any bleeding that might be present with an open fracture. Seek medical attention immediately.

Rehabilitation and Prevention for Tibia / Fibula Fractures

After the fracture has healed, it will be necessary to rebuild the strength and flexibility of the muscles in the lower leg. Range of motion activities may be needed for the knee and ankle depending on the location of the fracture and the extent of immobilisation required. When the fracture has healed a gradual re-entry into activity must be observed to prevent re-injury. Strong calf and anterior tibialis muscles will help protect the tibia and fibula.

Long-term Prognosis for Tibia / Fibula Fractures

If set properly and allowed to heal fully, a fracture should not present any future problems. In some cases a rod or pins may be needed to hold the bones in place during healing. Surgery may be required in a few cases where blood vessel or nerve damage is severe.

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Posterior Tibial Tendon

Brief Outline of Posterior Tibial Tendinitis

Pain along the medial (inner) side of the lower leg, ankle, and foot may be the result of posterior tibial tendinitis. The posterior tibial tendon helps hold the longitudinal arch of the foot, which means there is a level of tension and friction in the tendon. If the arch falls, the stress on the tendon increase. This can occur with poor running mechanics, improper footwear, or untreated injuries.

Anatomy and Physiology for Posterior Tibial Tendinitis

The posterior tibial tendon runs from the calf muscle behind the medial malleolus (the bony prominence) of the ankle, to the navicular bone in the arch of the foot. This tendon supports the arch and aids in inversion of the foot. If the navicular moves out of place, it causes stress and irritation to the tendon. This irritation over time becomes tendinitis, inflammation of the tendon.

Posterior Tibial TendonPosterior Tibial Tendon Pain

Cause of Posterior Tibial Tendinitis

Improper running mechanics. Improper footwear. Prior  injury to the medial side of the ankle.

Signs and Symptoms of Posterior Tibial Tendinitis

Pain and tenderness over the inner side of the shin, ankle, and foot. Pain when walking or running. Some swelling may be noted over the tendon.

Complications if Left Posterior Tibial Tendinitis Unattended

If left unattended, this condition can lead to a fallen arch or a complete rupture of the tendon. The pain may cause a change in footfall during running leading to injuries in other structures of the foot and ankle.

Immediate Treatment for Posterior Tibial Tendinitis

R.I.C.E. Anti-inflammatory medication.

Rehabilitation and Prevention for Posterior Tibial Tendinitis

After pain subsides, it is important to stretch and strengthen the calf muscles to support the tendon and speed recovery. Arch supports may be required until the tendon heals and the muscles are strengthened. Gradual reintroduction into activity is important and proper warm-ups will help prevent a recurrence of the injury. Proper footwear and corrections of any mechanical inefficiency will also help prevent this injury.

Long-term Prognosis for Posterior Tibial Tendinitis

Proper treatment should lead to a complete recovery. The longer the condition exists before treatment the longer recovery will take.

Call (+65) 6471 2674 (24 Hour) to check your posterior tibial tendon today.