Forefoot Flexibility and Medial Tibial Stress Syndrome
The purpose of this study was to investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches.
Flatfoot deformity is an intrinsic risk factor of MTSS but the association between flatfoot and MTSS remains controversial.
Inadequate flexibility of the foot may result in foot and lower-extremity injuries.
131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet, flat feet or MTSS feet.
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The foot posture was assessed while standing.
The medial longitudinal arch (MLA) ratio was the percentage of the height of the inferior border of the navicular from the floor divided by the foot length.
The transverse arch length (TAL) was the percentage of the length from the first metatarsal head to the fifth metatarsal head divided by the foot length.
The MLA ratio and TAL were measured in both rearfoot and forefoot loading positions.
It was found that when the MLA ratio was <11.9%, the risk of MTSS increased 4.8 times and when the flexibility of the transverse arch (diff-TAL) was <0.61%, the risk of MTSS increased 9.8 times.
The MLA ratio did not differ significantly between MTSS feet and flat feet.
Rather, the flexibility of the transverse arch was significantly lower in MTSS feet than normal feet and flat feet.
Both the MLA and the transverse arch can affect MTSS.
The TAL and diff-TAL reflect the structure and function of the transverse arch.
A foot with decreased flexibility of the transverse arch cannot buffer loading stress, resulting in increased loading stress to the tibia.
Moreover, decreased forefoot flexibility increases the mechanical stress to the tibial periosteal and the deep flexor fascia increases by increasing the activity of the tibialis posterior muscles, the flexor digitorum longus, and the soleus.
Thus, decreased flexibility of the transverse arch (rather than the height of the arch) is a risk factor for MTSS.
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References:
- Kudo S., Hatanaka Y. (2015) Forefoot flexibility and medial tibial stress syndrome. Journal of Orthopaedic Surgery: December 2015, Vol. 23, No. 3, pp. 357-360
 and morphology and flexibility of the foot arches.
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