29/11/2024
Mtss/shin splint/scheenbeenvlies ontsteking.
Artikel beschrijft dat de oorzaak van mtss eerder door tibia buigkrachten komt op het zwakste deel van de tibia (onderste 1/3 van het been). Waar de pijn ook meestal zich manifesteert.
Spierspanning werd ook altijd als oorzaak beschouwd. Maar hier is te zien dat de meeste spieren hun oorsprong vinden hogerop het been.
Toch meer een biomechanische oorzaak dan een tractie probleem van aanhechtende spieren? Correlatie hiertussen?
Bij herhaaldelijke mtss klachten is het dus interessant om altijd een podoloog te contacteren.
Zo kan de dynamiek van het onderbeen ook in kaart gebracht worden, en kunnen we deze buiging op het onderbeen ook verlichten/verminderen.
Dit doormiddel van schoenadvies en/of podologische zolen.
Medial Tibial Stress Syndrome: A Soft-Tissue Traction Injury??
The biomechanical etiology of medial tibial stress syndrome (MTSS) is still a matter of academic debate. In other words, we must still ask, what mechanical factors are most responsible for the injury to the bone of the medial tibial border that results in MTSS? One of the proposed biomechanical etiologies for MTSS is that muscle or fascia exerts excessive traction or tension forces on the medial border of the tibia.
The posterior tibial (PT), flexor digitorum longus (FDL), flexor hallucis longus (FHL) and soleus muscles, in addition to the soleus fascia, have all been implicated as being possible sources for a traction injury to the medial tibia that could cause the pain of MTSS. The proponents of this possible etiology of MTSS state that since anti-pronation foot orthoses tend to lessen the pain of MTSS, it is likely that increased traction on any one, or all, of these muscles and fascial structures is the prime etiology of MTSS.
Unfortunately, the area along the medial tibial border, where MTSS most commonly occurs, is generally accepted to be located at the junction of the distal third and proximal two-thirds of the medial tibial border. This is not the location where any one muscle or fascial structure attaches to the medial tibial border.
In the illustration in their paper from 1994, Beck and Osternig clearly showed that the origins of neither the PT, FDL, FHL and soleus muscles correspond to the pain associated with MTSS (Beck BR, Osternig LR: Medial tibial stress syndrome: the location of muscles in the leg in relation to symptoms. JBJS, 76A:1057-1061, 1994). The location of MTSS pain is indicated by the large arrows in the distal medial tibial border in the illustration below.
This problem with lack of soft-tissue structure attachment to the area of MTSS pain has led many to believe that the prime biomechanical etiology of MTSS is not soft-tissue traction, but rather that the main etiology of MTSS is excessive bone-bending of the tibial shaft during running and jumping activities. In summary, most experts now consider MTSS to be a bone bending injury which will be covered in future posts.
Kirby KA: Current concepts in treating medial tibial stress syndrome. Podiatry Today. 23(4):52-57, 2010.
