The tibialis anterior muscle occupies 2/3 of the space on the front of the lower leg. It has an elongated shape, located between the lateral condyle and the interosseous membrane. The tibialis anterior tendon originates in the lower third of the leg and inserts into the center of the instep.
In the human body, this muscle performs 2 main tasks - supination of the foot and maintaining balance. Supination is the ability of a limb to perform rotational movements.
The tibialis anterior muscle plays a special role during physical activity.
When walking (when moving the back leg), running, skating, it is responsible for the back
extension of the foot, its movements at this moment are as dynamic as possible. In sports and rhythmic gymnastics, ballet, and figure skating, its function is to fix the ankle joint.
Common Causes of Pain
Muscle pain syndrome is caused by spasm. To determine the cause of the pain, you need to analyze your previous day.
The reasons may be the following:
- Trauma and overexertion. Pain occurs when the integrity of muscle fibers is damaged and there is increased tone.
- Poor posture. Sitting at a table for a long time in the wrong position, wearing uncomfortable shoes, skewing the body to one side - all these factors contribute to the appearance of pain.
- Emotional stress. Especially typical for children. Stress often causes muscle tone.
- Myalgia. A disease accompanied by insomnia. It is characterized by muscle pain on all sides.
- Excessive physical activity. Typical for men involved in heavy sports or in the gym.
- Myositis. The inflammatory process in muscle fibers develops after infections or injuries. The pain intensifies with movement.
During active exercise in the gym, lactic acid accumulates in the muscles, and microcracks may appear in the fibers. Before each approach, it is recommended to shake the limb to disperse the fluid that puts pressure on the nerve endings.
Pain after training can be natural or pathological. Natural ones occur in the following cases:
- after the first workout, since the body is not yet accustomed to the stress;
- after a long break;
- when adding new exercises to the program;
- with increased intensity of exercise.
To relieve pain of this nature, it is enough to stretch and take a warm shower after finishing the workout.
Pathological pain is characterized by severity and duration. Occurs in cases:
- incorrect execution of exercises;
- classes without warming up and stretching;
- poor nutrition;
- excessive physical activity.
Additional symptoms may appear - hematomas, swelling. If such pain occurs, you must stop training and immediately consult a doctor. In the future, it is important to give the muscles proper rest between workouts so that they have time to recover.
During classes, you need to listen carefully to the trainer, follow the exercise technique, and do warm-up and stretching before and after training.
Lack of sleep, daily grueling workouts, poor nutrition - all these factors have a detrimental effect on the condition of the muscles.
How does pain in the lower leg manifest itself in obliterating atherosclerosis of the lower extremities?
In diseases of the arteries of the legs, the delivery of blood to the muscles of the lower leg is disrupted. As a result, the muscles cannot work for a long time, as they quickly get tired from the lack of oxygen and nutrients. This is manifested by a feeling of fatigue, pain or cramps in the lower leg muscles when walking a certain distance, after which the patient is forced to stop. After a few minutes of rest, the pain goes away and the patient can resume walking again. Having walked the same distance as the first time, he is forced to stop again. Thus, the patient’s usual walking distances turn into walking with stops. With timely contact with a vascular surgeon, it is possible to reduce or completely eliminate such complaints.
Causes and symptoms of tibial syndrome
Types of Calf Muscles
If you experience pain in your tibialis anterior muscle, it is likely due to a condition called anterior tibial syndrome, or shin splints. There are several factors causing this condition:
- Flattened arch of the foot (flat feet). Causes a divergence of the bones between the shin and the metatarsus, this increases the load on the tendons of the front of the shin and provokes pain in the lower third.
- Tendinitis. Inflammation can affect all tendons of the leg. It occurs mainly due to running on unsuitable surfaces, which causes one foot to regularly roll inward. A one-time increased pronation (dislocation) can also cause tendinosis.
- Tenosynovitis. Another type of inflammatory process. Localized in the tissues of the tendon sheath.
- Syndrome of the anterior fascial bed of the leg. Injuries that cause swelling of muscle tissue (bruises) create pressure in the area where the deep peroneal nerve and anterior tibial vessels - artery and vein - are located.
- Stress fractures. This bone damage is the result of increased physical activity. It occurs most often in sprinters and marathon runners. The manifestation of tibial syndrome in this case is preceded by inflammation of the periosteum.
- Insufficient recovery from previous injury. Enough time must pass for the ligaments to recover, otherwise the risk of relapse is high.
- A sharp increase in physical activity. The workout should begin with a warm-up, and its intensity should correspond to the person’s level of training.
With the development of tibial syndrome, pain in the lower leg is noted, which is especially severe in the morning. In advanced cases, pain is felt when moving, discomfort during palpation and swelling. If neuralgia occurs, that is, damage to the nerve, the patient’s gait changes, it becomes awkward, with emphasis on the toes.
This is due to the fact that the innervation of the tibial nerve is disrupted.
As soon as you feel that the tibialis anterior muscle hurts when walking or begins to cramp, you must urgently reduce the load and consult a doctor.
Peroneal tendons
Injuries to the peroneal tendons are a fairly rare diagnosis. It is problematic to establish the actual frequency of occurrence, given the low awareness of it among both patients and traumatologists themselves, diagnostic difficulties, and the lack of a diagnostic and treatment protocol. Dislocation of the peroneal tendons due to the anterior lateral malleolus most often occurs among young, athletic patients, but it can also occur in older age groups in the presence of instability in the ankle joint.
- rapid dorsiflexion of the inwardly turned foot.
-sharp contraction of the peroneus brevis and longus muscles
Dislocation of the tendon leads to its traumatization against the ridge located longitudinally along the posterior surface of the fibula, which ultimately leads to its longitudinal splitting along the fibers and spreading. There are cases of transverse rupture, but they are much rarer. The tibialis and peroneus tendons are located in one common synovial sheath, which is divided only at the level of the lateral malleolus.
The peroneus longus tendon is located posterior to the peroneus brevis tendon. They pass in one fibrocartilaginous canal, only about 5 mm deep, delimited along the posterior surface by the superior retinaculum of the peroneal muscles.
| norm | |
| 1st degree - the retinaculum is partially detached from the fibula, which leads to subluxation of the peroneal tendons | |
| 2nd degree – the retinaculum is separated from the fibrocartilaginous crest, which leads to pinching of the tendons between the crest and the retinaculum | |
| Grade 3 – avulsion of the fibrocartilaginous ridge along with the periosteum or cortical plate, which leads to subluxation of the tendons between the bone and the torn fragment | |
| 4th degree - the retinaculum is torn from the heel bone, the tendons are dislocated under the skin. |
Patients often describe the injury as a sudden, violent dorsiflexion of the foot, and they often feel a popping or popping sensation in the lateral ankle area.
Patients complain of clicking, crackling, a feeling of instability and pain along the outer surface of the ankle joint.
Upon examination, in the case of an acute injury, swelling is detected along the posterior surface of the outer ankle, pain on palpation of the tendons of the peroneal muscles, and when the muscles are tense, subluxation of the tendons can be seen. With passive dorsiflexion, the patient experiences a feeling of subluxation and instability; sometimes it is possible to palpate the dislocated tendon.
Sonography and MRI play an important role in diagnosis; examination often reveals such anomalies as the 4th peroneus muscle, the low-lying belly of the peroneus brevis muscle.
Among non-professional athletes, conservative treatment is possible. A circular plaster cast of the foot and lower leg is applied in a neutral position, walking with additional support on crutches for a period of 6 weeks. The result of conservative treatment is good in 50% of cases. But for the average person, not an athlete, this result may be quite sufficient.
Among professional athletes, surgical treatment is recommended.
In case of acute injury, the integrity of the tendon retinaculum is restored. In case of old, chronic injuries, there is a deepening of the groove on the posterior surface of the fibula. The tendon retinaculum can also be replaced with a graft from the plantaris tendon, and the groove can be deepened through bone block transplantation/osteotomy.
In some cases, there is a so-called Split injury, a longitudinal separation of the tendon of the peroneus brevis muscle. In this case, rupture of the retinaculum does not occur, as well as dislocation of the tendons from the groove. Flattening and spreading of the tendon can be detected by MRI; the clinical picture for this pathology is similar to that for dislocation of the peroneal tendons. Conservative treatment is ineffective. Surgical treatment is recommended: in case of acute injuries, tubularization of the tendon; in case of chronic injuries, debridement and tenodesis of the proximal and distal parts with the peroneus longus tendon. It is also possible to use an autograft or allograft.
In addition to dislocations/transverse and longitudinal tears, damage to the peroneal tendons can manifest itself in the form of tendinitis and tendinosis. The provoking factor is usually functional overload. Swelling, pain in the projection of the tendons of the peroneal muscles, gait disturbance, pain intensifies when walking is determined.
Damage can be at various levels, both proximal - above the level of the lateral malleolus, and at the level of the fibular tubercle of the calcaneus, the inferior peroneal retinaculum, and the insertion site.
Treatment depends on both the location and nature of the damage. In the early stages, it is possible to use conservative methods. Chronic tenosynovitis leads to swelling, thickening of the tendon, it is pinched in its channel, which provokes further deterioration of the condition. Depending on the level at which the tendon is pinched, it may require its release at the level of the upper/lower retinaculum, osteotomy of the fibular tubercle of the calcaneus, removal of degeneratively changed areas of the tendon with possible auto or alloplasty.
Treatment of tibial syndrome
Cold compress to neutralize inflammation in the knee area
Treatment of the syndrome does not oblige you to completely stop training. However, it is necessary to regularly provide rest to the injured limb.
If your tibialis anterior muscle hurts when running, you may want to increase your cadence by 10%.
This will help reduce the traumatic impact on the tibia.
It is also necessary to apply cold to the injured limb to neutralize inflammation. The main rule is to wrap the ice in a towel to prevent direct contact with the skin. As part of anti-inflammatory therapy, you can also use ointments, lotions, and shock wave therapy.
Massage will help relieve tension, restore blood supply to the limb and tone the muscles.
Wearing new high-quality shoes will not only make you happy, but will also contribute to the correct distribution of pressure in the lower leg and provide good support to the foot.
It is important to exercise your legs regularly. Strengthening and stretching the muscles will make them more elastic and also protect the tibia from cracks and fractures. This has a beneficial effect on both the condition of tendon tissue and strength qualities. In addition, all the proposed measures will help restore the ability of the tibial nerve to innervate the surface of the leg.
If treatment at home does not help, spasms occur, you should seek medical help.
After conducting an examination, the doctor will be able to tell why the pain does not go away. Modern diagnostic methods identify many diseases, such as transposition of the posterior tibial muscle, tear and rupture of ligaments and tendons.
How to determine anterior TM injury
It is not easy for a person ignorant of anatomy to imagine the structure of his own skeleton. If pain occurs below the knee, but above the ankle on the outside of the lower leg, the problem must be looked for in the anterior muscle.
It is responsible for lifting the foot in the body, its inclination, maintaining balance when we stand, and is maximally active during dancing and sports. One of the symptoms of injury is painful mobility and weakness in the ankle joints, making it impossible to walk calmly.