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Miette F. Loopik, Marinus Winters and Maarten H. Moen

Introduction:

No reports have been published on the results of corticosteroid injections for medial tibial stress syndrome (MTSS).

Case Presentation:

The authors present 2 cases of women with MTSS who showed atrophy and depigmentation of the skin after pretibial corticosteroid injections. Case 1 is an 18-y-old woman presenting with pain in her lower leg for 12 mo. No improvement was noticed after conservative treatment, so she received local injections with corticosteroids. Five months later physical examination showed tissue atrophy and depigmentation around the injection sites. Case 2 is a 22-y-old woman who presented with pain in both lower legs for 24 mo. Several conservative treatment options failed, so she received local injections with corticosteroids. Physical examination revealed tissue atrophy and depigmentation around the injection sites.

Conclusion:

No positive effect of injections with corticosteroids was found in 2 cases of MTSS. Furthermore, considerable tissue atrophy and hypopigmentation of the skin was observed.

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Katherine R. Newsham, Matthew D. Beekley and Christine A. Lauber

Context:

Exercise-related medial leg pain (ERMLP) is a common complaint among athletes, and efforts toward rehabilitation are often unsuccessful.

Objective:

To evaluate the efficacy of a therapeutic intervention in ERMLP localized to soft tissue.

Design:

A quasi-experimental, nonequivalent control-group study.

Setting:

Athletic training facility.

Patients:

20 volunteer male and female athletes (18–22 y old) with ERMLP. Complete data were available for 13 participants.

Intervention:

Treatment group (TRE, n = 7) received therapeutic intervention focused on relieving muscle hypertonicity in the deep compartment of the lower leg and restoring balance of the toe flexors and extensors. Control group (CON, n = 6) received no intervention.

Main Outcome Measures:

Self-reported pain intensity, pain threshold, and extensor hallucis longus to extensor digitorum brevis (EHL:EDB) electromyography ratio.

Results:

There were no significant differences in age, duration of symptoms, or pain measures between the 2 groups at baseline. CON demonstrated no significant changes in any of the outcome measures in posttreatment testing, but significant between-groups differences were identified for pain during activity (CON mean = 6.5, 95% CI 5.05, 7.95; TRE mean = 3.5, 95% CI 1.67, 5.33; P = .01), change scores for pain during activity (CON mean = 0.33, 95% CI −1.25, 1.91; TRE mean = −3.43, 95% CI:−4.6, −2.25; P < .001), change scores in pressure threshold (CON mean = −0.25, 95% CI −0.74, 0.23; TRE mean = 0.72, 95% CI 0.22, 1.37; P = .006), and change in EHL:EDB ratios (CON mean = 0.05, 95% CI −0.22, 0.33; TRE mean = 1.07, 95% CI 0.75, 2.07; P < .046).

Conclusion:

Therapeutic interventions focused on restoring muscle balance appear to be effective in resolving ERMLP.

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Nathaniel S. Nye, Drew S. Kafer, Cara Olsen, David H. Carnahan and Paul F. Crawford

posterior) tendinitis 726.79 Peroneal tendinitis 844.9 Shin splints (MTSS) Foot and toes 733.94 Stress fracture of the metatarsals 728.71 Plantar fasciitis 734 Flat foot 726.73 Calcaneal spur Abbreviations: CM, clinical modification; ICD-9, International Classification of Diseases, 9th Revision; MTSS