[Internal tibial pain in runners]

Certain pains located along the internal boundary of the tibia in its middle third appear sometimes in young athletes who have come to racing comparatively late. The pains improve with rest, but nevertheless end up by being subintrant. The worst pain is located at the tibial insertion point of the common flexor of the toes, and of the soleus muscle. An accentuation of tarsal pronation often accompanies the pain syndrome, this in turn sometimes being accompanied by excessive valgisation of the back of the foot. Torsion disorders of the lower limb are another component of the picture. Intensive training and certain propulsion exercises on tiptoe seem to trigger off these disorders. Radiography can show moniliform cortical adaptations. Bone scintigraphies using marked technetate mainly show the areas of longitudinal hypercaptation on the internal boundary of the tibia. Pain is triggered off by the excessive use of the common flexor of the toes and by partial rupture of the aponeurosis at the point of tibial insertion of the soleus. The pressure measurements of the deep posterior space do not suggest a lodge syndrome; however, certain histopathological pictures do suggest the existence of an ischemical phenomenon. The orthopaedic treatment is based on an understanding of the deficient mechanisms functioning during foot pressure on the ground in racing. Corrective footwear and slow, gradual training techniques can help with these problems. Sometimes the pains become resistant to all conservative treatment and will respond favourably to an aponeurotomy associated with partial disinsertion of the soleus and common flexor of the toes.