Measurement of tibiofibular varum in subjects with unilateral overuse symptoms

Lower extremity overuse injuries due to repeated microtrauma are often asymmetrical in nature. The purpose of this study was to determine if the amount of tibiofibular varum was asymmetrical in individuals with unilateral overuse injuries. The subjects were 20 patients who developed unilateral overuse symptoms of the leg and foot due to compensatory subtalar joint pronation. The distal one-third of the leg was bisected with the subjects standing in their normal base of support. The angle of this bisection to vertical was measured with a fluid inclinometer to determine the amount of tibiofibular varum. This measurement was performed in relaxed calcaneal stance and subtalar joint neutral stance. A single examiner performed all of the measurements and was blinded to the side of the subject's symptoms. A two-way analysis of variance for repeated measures was performed. There was a significant difference in the amount of tibiofibular varum between the injured and the uninjured extremities. There was also a significant difference between the measurements of tibiofibular varum when comparing the resting calcaneal stance and the subtalar joint neutral stance positions. This difference in tibiofibular varum between the injured and uninjured extremities may be one example of an asymmetry that can cause unilateral overuse symptoms.