Intrinsic Foot Muscle Training for Medial Tibial Stress Syndrome

Abstract

Medial tibial stress syndrome (MTSS), a common condition in physically active individuals, is widely studied, yet effective and efficient intervention is elusive. We compared the effects of a 2-week neuromuscular-based intervention to the “usual treatment” in a non-randomized trial involving intercollegiate athletes with complaints of MTSS involving soft tissue. The neuromuscular-based intervention focused on relieving trigger points in the deep compartment and improving intrinsic foot muscle (IFM) function. The control group received “usual treatment” that did not include the study exercises, but did include rest, modalities, stretching, and/or strengthening exercises. Pre- and post-intervention measures included pain at rest, during activities of daily living (ADL), and during activity; pressure-pain threshold on soft tissue; the Foot & Ankle Ability Measure (FAAM); FAAM Sports Subscale; and Exercise-Induced Leg Pain Questionnaire (EILPQ). Patients were followed for 3 months for recurring symptoms. The experimental group (NMTx) had significantly greater improvement in pain during activities of daily living (change -2.5 NMTx; -0.5 CON; P=.03), pain during activity (change -4.5 NMTx; -0.33 CON; P<.001), and pressure-pain threshold (change +2.41 NMTx; -0.03 CON; P=.001). The NMTx group also reported greater improvement on the self-reported FAAM Sport-Subscale (change +40 NMTx; +6.5 CON; P=.001) and had a higher global rating of change (4.71 NMTx; 3.5 CON; P=.008). Recurrence of symptoms within 3 months was reported by 7% of NMTx and 87% of CON. This study demonstrates a neuromuscular-based intervention aimed at relieving soft tissue tenderness in the deep compartment and improving IFM function provides significant and sustained relief of leg pain.