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Comparative Study
. 2024 Dec 16:2024:8827692.
doi: 10.1155/bmri/8827692. eCollection 2024.

MRI-Based Morphometric Comparison of Lower Leg Muscles and Tendons in Individuals With Medial Tibial Stress Syndrome

Lucas Nogueira de Oliveira  1   2 , João Luiz Quagliotti Durigan  3 , Caroline Ribeiro Sanchez  4 , Henrique Mansur  5 , Andressa Beatriz Beltrão Rosa  4 , Rita de Cássia Marqueti  2
Affiliations
Comparative Study

MRI-Based Morphometric Comparison of Lower Leg Muscles and Tendons in Individuals With Medial Tibial Stress Syndrome

Lucas Nogueira de Oliveira et al. Biomed Res Int. .

Abstract

Runners frequently suffer from medial tibial stress syndrome (MTSS), often linked to excessive eccentric muscle contractions causing periosteal traction by the muscles in the deep posterior compartment. However, the effects of MTSS on these muscles and tendons remain underexplored. This study is aimed at investigating changes in muscle and tendon volumes in this compartment, as well as cross-sectional area measurements, using magnetic resonance imaging. Thirty individuals were divided into two groups: MTSS (n = 18; mean age 30.3 ± 12.4) and control (n = 12; age 35.2 ± 9.2). The anterior, deep posterior, superficial posterior, and lateral compartment muscles, along with their respective tendons, were compared between groups, and possible sex differences were also evaluated. The deep posterior compartment showed a significant volume difference of 0.41 cm3/kg3/4 in the MTSS group (p = 0.034), primarily due to the flexor hallucis longus (FHL), which had a 0.55 cm3/kg3/4 greater normalized volume (17.12% greater mean muscle volume) compared to controls (p = 0.023; Cohen d = 0.895). No association between sex and MTSS was found (p = 0.752). In conclusion, the FHL muscle exhibited increased normalized volume in the MTSS group compared to controls, with no sex-related differences in MTSS. Clinicians should consider the assessment of FHL muscle volume in routine evaluations of patients presenting with symptoms suggestive of MTSS.

Keywords: MRI; MTSS; deep posterior compartment; flexor hallucis longus; muscle volume.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
3-D magnetic resonance rendered image and segmented slices of a MTSS group participant. (a) Anterior view, (b) posteromedial view, and (c) slice axial cross-sectional areas. ID, interslice space of 2.4 cm; FHL, flexor hallucis longus; FDL, flexor digitorum longus; TP, tibialis posterior.
Figure 2
Figure 2
Bar graphs comparing (a) lower leg deep posterior compartment muscle volume, (b) lower leg superficial posterior and lateral compartment muscle volume, and (c) lower leg anterior compartment muscle volume. Red dotted loops indicate comparisons between muscle groups between MTSS standard deviation. MTSS = medial tibial stress syndrome group, control = control group, cm3 = cubic centimeter.
Figure 3
Figure 3
(a) Bar graphs comparing lower leg deep posterior compartment muscle maximum axial cross-sectional area (ACSA). (b) Bar graphs comparing anterior compartment muscle maximum axial cross-sectional area (ACSA). (c) Bar graphs comparing superficial posterior and lateral compartment muscle maximum axial cross-sectional area (ACSA). SD = standard deviation, MTSS = medial tibial stress syndrome group, control = control group, cm2 = square centimeter. There were no differences between groups (p > 0.05).
Figure 4
Figure 4
Bar graphs comparing lower leg tendon maximum axial cross-sectional area (ACSA) excluding anterior compartment tendons. SD = standard deviation, MTSS = medial tibial stress syndrome group, control = control group, cm2 = square centimeter. There were no differences between groups (p > 0.05).
See this image and copyright information in PMC

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