Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome

Abstract

Although women reportedly have a higher prevalence of medial tibial stress syndrome (MTSS) than men, the possible role of gender-based anatomical differences has not been investigated. The aim of the present study was to investigate the presence of gender-based differences in the range of muscle attachments along the entire medial tibia, the proportion of muscle attachment at the middle and distal thirds of the medial margin of the tibia, the structure of the crural fascia, and chiasm position. The specimens were 100 legs of 55 Japanese cadavers. Statistical analysis was carried out using a chi-square test to compare anatomical features between the sexes. The flexor digitorum longus (FDL) had a higher proportion of attachment to the middle and distal thirds of the medial margin of the tibia than the soleus (SOL; P < 0.001). The proportion of the SOL attachment to the middle and distal thirds of the medial margin of the tibia was 33.3% in men and 72.5% in women (P < 0.001). The soleal aponeurosis was not observed in any specimen. In all specimens the FDL formed the top layer of both chiasms. These results suggest that the higher prevalence of MTSS reported among women may be the result of gender-based anatomical differences.

Diaphyseal cross‐sectional geometry of the metatarsal bones in the Jomon population

“…However, several factors other than mechanical loading may cause sex‐related differences. Many studies reported that there were differences in the morphology of the foot based on sex, including arch rigidity (Zifchock, Davis, Hilstrom, & Song, ), intersegmental motion (Lee, Seo, Kim, Kim, Lee, & Choi, ; Takabayashi et al, ), origin of the muscles (Edama et al, ), foot shape (Lee, Kouchi, Mochimaru, & Wang, ; Tomassoni, Traini, & Amenta, ; Seghazadeh, Kitano, & Okura, 2015; Smith, ; Wunderlich & Cavanagh, ), and the plantar loading pattern (Chiu, Wu, & Chang, ; Putti, Arnold, & Abboud, ,b; Queen, Vap, Moorman, Carrett, & Butler, ; Sims, Hardaker, & Queen, ). Furthermore, sexual hormones affect the sex‐based differences in bone robustness (Haapasalo, Sievanen, Kannus, Heinonen, & Oja, 1996; Järvinen et al, ; Kannus et al, ).…”

Forefoot and hindfoot kinematics in subjects with medial tibial stress syndrome during walking and running

“…In the current study, subjects with MTSS exhibited greater hindfoot and forefoot eversion and abduction during walking and running than subjects without MTSS. The tibialis posterior originates from the posterior of the tibia and fibula and attaches to the navicular, cuneiform, and second through the fourth metatarsal base . The flexor digitorum longus and soleus originate from the posteromedial border of the tibia, and attach to the distal phalanges of the foot and medial calcaneal tuberosity, respectively .…”

“…The tibialis posterior originates from the posterior of the tibia and fibula and attaches to the navicular, cuneiform, and second through the fourth metatarsal base . The flexor digitorum longus and soleus originate from the posteromedial border of the tibia, and attach to the distal phalanges of the foot and medial calcaneal tuberosity, respectively . The soleus is an invertor of the calcaneus .…”

“…24 The flexor digitorum longus and soleus originate from the posteromedial border of the tibia, and attach to the distal phalanges of the foot and medial calcaneal tuberosity, respectively. 24 The soleus is an invertor of the calcaneus. 25,26 The increase in hindfoot and forefoot eversion may contribute to the stretching of these muscles and tendons.…”

Muscle assessment using multi‐frequency bioimpedance in a healthy Danish population aged 20–69 years: a powerful non‐invasive tool in sports and in the clinic

“…Looking at anatomical differences between men and women, Edama and colleagues () showed gender‐based differences in the attachment and position of the muscle and fascia on the tibia. This most likely explains some of the reason for the higher incidence of medial tibial stress syndrome in women athletes compared with men.…”