Tibialis anterior muscle hernia: rare but not uncommon

Abstract

Muscular hernias in the lower limb are a rare entity that have seldom been described in the literature, to the extent that the seminal paper on the subject remains a case series from 1929. Here, we present a case of tibialis anterior muscle hernia and discuss the aetiology behind the same. Furthermore, we attempt to amalgamate existing knowledge to provide some guidance for investigation and management of this important diagnostic consideration.

Tibialis anterior muscle herniation in adolescents: A case series and review of the literature

“…Patients are often athletes, have a history of lower extremity trauma, or are exposed to long periods of repetitive standing or upright exercise . They may endorse pain, neuropathy, and cramping exacerbated with exercise, although usually they are asymptomatic . They have been associated with piezogenic papules of heel and wrist caused by fat herniation through the dermis …”

“…6,8,12 They may endorse pain, neuropathy, and cramping exacerbated with exercise, although usually they are asymptomatic. [2][3][4]13,14 They have been associated with piezogenic papules of heel and wrist caused by fat herniation through the dermis. 9 The differential diagnosis includes soft tissue sarcoma, leiomyoma, angiolipoma, muscle rupture, and vascular malformations or tumors 1-4,9 (Table 1).…”

“…The differential diagnosis includes soft tissue sarcoma, leiomyoma, angiolipoma, muscle rupture, and vascular malformations or tumors (Table ). Clinical diagnosis of anterior tibialis herniation rests on the disappearance or change in nodule size with manipulation of the lower extremity .…”

“…For symptomatic patients, treatment includes compression stockings, rest, activity modification, and physical therapy . Longitudinal fasciotomy is the preferred surgical treatment and reserved for those who fail conservative therapy or have clear evidence of nerve entrapment on imaging . Other traditional surgical options include fascial or periosteal grafts, mesh, and direct closure .…”

“…About 200 cases of lower extremity muscle herniation are described in the literature, but the true incidence is unknown . These herniations are usually asymptomatic and present as subcutaneous nodules of the lower extremity that change with limb position . They appear to be more common in men; however, there are recent case reports in women and in the adolescent population .…”