Case Study: Medial Tibial Stress Syndrome in a 20-Year-Old Female Runner

Medial Tibial Stress Syndrome

Case Study: Medial Tibial Stress Syndrome in a 20-Year-Old Female Runner

A 20-year-old female runner presented at Leading Edge Podiatry with pain along the inner border of her left shinbone. She reported that the pain had been present for approximately 4 weeks and had gradually worsened over time. She has previously suffered from shin pain in previous seasons of playing netball. She was generally health and not taking any medication. She was keen to play in the netball finals later in the year and had been unable to run due to the shin pain.

Patient’s Pain Symptoms

Cae Study Stress Pain Pic 1

The patient reported that the pain was present in her left shinbone. The onset of shin pain was when she first noticed a dull ache in her shin after running. The pain was initially mild but gradually worsened over time. The pain was worse when running and when walking on hard surfaces. The patient described the pain as a dull, aching sensation in the shin.




Examination and Assessment

The podiatrist carried out a thorough examination, beginning with a comprehensive history-taking. The patient’s leg was examined and palpated; the pain was worse when pressing along the inner border of the shinbone. It was particularly sore in the lower half of the shin bone. It was generalised and not localised to a focal spot. The podiatrist also assessed the patient’s range of motion and gait. It was noted her feet pronated moderately/severely and she was a heavy heel striker.

Diagnosis and Treatment

Cae Study Stress Pain Shockwave Pic 1 The podiatrist diagnosed the patient with medial tibial stress syndrome. The podiatrist recommended a course of shockwave therapy to help promote healing in the injured area and loosen the tibialis posterior muscles where they attach to the shin bone. Shockwave therapy was delivered weekly for 4 weeks followed by fortnightly for an additional 2 sessions. After each session of shockwave therapy, the patient felt better. The podiatrist also advised the patient to stretch the calf and shin muscles and strengthen the foot and ankle muscles. The patient was prescribed orthotics to help support the tibialis posterior muscles and provide good shock absorption. She was advised to wear supportive shoes with a cushioned sole and to avoid walking on hard surfaces.

After 10 weeks of treatment, the patient reported a significant reduction in pain and was able to return to running and playing netball. The patient was advised to continue with the physical therapy exercises and to wear supportive shoes as directed.

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