What exactly do you mean by you ' have run a high frequency ultrasound over
the bone without pain'?
----- Original Message -----
From: "Andrew Tindall" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, August 16, 2002 7:06 PM
Subject: Anterior tibial pain
> Dear Physio's
> As a podiatrist on this list I am asking for your input on a patient where
my expertise runs out.
> A 31 year old male with bilateral pain mid tibia. Initailly thought it
was anterior compartment syndrome but now not so sure. There is tenderness
slightly on Extensor Hallucis Longus muscle belly but mainly on the tibia
itself. The pin point epicentre of the pain is actually just medial to the
anterior border of the tibia. I have run a high frequency ultrasound over
the bone without pain so I don't think it is a stress fracture.
> The patient has worked out in the gym on exercise bike and eliptical
jogger, but avoids treadmill work. This petered off during the world cup
and he has not got back into things again except cricket. He is a medium
seam bowler with a 17 step run up. He plays once or twice a week in evening
matches and bowls 3-4 overs each game. Pain comes on during the third or
fourth over. This week he played Mon and got pain late on, then Wed and had
pain from the start. A while ago, after not playing for a fortnight, he was
on a golf course and did a short, light jog along the fairway (not with bag)
and could feel a slight dull ache coming on after about 20 steps.
> In gait, his hallux dorsiflexes markedly. He has a forefoot varus (2-5)
but with a flexible plantarflexed first ray making the 1-5 met head
relationship parallel to the transverse plane of the rearfoot. He wears
rigid orthoses in his cricket shoes, but I think I will have to add a
forefoot extension for post heel lift in gait and running.
> So, does anyone have any ideas what this is, and the best way of treating
it. His cricket season has finished but he wants to resume running and
football in two or three weeks (all on grass).
> Thanks in advance