Clinical Case Study: Elite Female Soccer Player With Medial Tibial Stress Syndrome

HISTORY: A 21-year-old elite female soccer midfielder presented with lower leg pain. In September, she was selected as a strongman and started to participate in the training of a professional team in addition to her regular training with her university soccer club. The training of the professional team required him to sprint with higher intensity than that of his university team, which increased the load on his lower leg, and he came to the university health center for examination. PHYSICAL EXAMINATION: The patient experienced pain in the right lower leg, which was the dominant leg. There were no problems with the range of motion of the ankle joint in plantar flexion and dorsiflexion. There were too many too signs only in the right leg. The windlass mechanism showed no pain in either side of the foot. The right foot was limited in the toe extension test. The heel raise showed inward return of both feet. Tenderness was observed over 10 cm from the anterior to posterior medial surface of the tibia.DIFFERENTIAL DIAGNOSIS:1. Inflammation of the tibial marrow2. Anterior and posterior tibial periostitis3. Tibial stress fracture TEST AND RESULTS: MRI of the axial and coronal planes of the affected side.— Inflammation of periosteum present, but not linear Detailed inflammation of the periosteumNo linear hyperechoic images were observed.FINAL/WORKING DIAGNOSIS:Medial tibial stress syndrome TREATMENT AND OUTCOMES: (1) Creation of insoles (lifting the medial longitudinal arch and talar bone to reduce the burden on the lower leg during running).(2) Improve muscle flexibility by stretching and massaging (using a foam roller, etc.) the anterior to posterior surfaces of the lower leg (triceps, tibialis anterior, tibialis posterior, flexor digitorum longus, etc.).(3) Isometric training to extensor contractions of the triceps, tibialis anterior, tibialis posterior, and flexor digitorum longus muscles (plantar dorsiflexion and internal/external bending) to build muscle strength to withstand loads.(4) Training to increase plantar rigidity through short foot exercises and toe opening and closing exercises.(5) Teach training with an awareness of the kinetic chain in order to reduce the burden on the lower leg (tibial hyper-rotation control exercises, activation training of the medialis muscle, lateral trunk tilt control training). Supported by: This work was supported by JSPS KAKENHI Grant Number JP22K17738. I acknowledge the use of parperpal (https://edit.paperpal.com/) to identify improvements in the writing style.