{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:29:18Z","timestamp":1789403358383,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"vor","delay-in-days":187,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"vor","delay-in-days":187,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Journal of Foot and Ankle Research"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Medial tibial stress syndrome (MTSS) is a common lower leg injury experienced by runners. Although numerous risk factors are reported in the literature, many are non\u2010modifiable and management of the injury remains difficult. Lower leg muscle structure and function are modifiable characteristics that influence tibial loading during foot\u2010ground contact. Therefore, this study aimed to determine whether long\u2010distance runners with MTSS displayed differences in <jats:italic>in vivo<\/jats:italic> lower leg muscle structure and function than matched asymptomatic runners.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Lower leg structure was assessed using ultrasound and a measure of lower leg circumference to quantify muscle cross\u2010sectional area, thickness and lean lower leg girth. Lower leg function was assessed using a hand\u2010held dynamometer to quantify maximal voluntary isometric contraction strength and a single leg heel raise protocol was used to measure ankle plantar flexor endurance. Outcome variables were compared between the limbs of long\u2010distance runners suffering MTSS (<jats:italic>n<\/jats:italic>\u2009=\u200920) and matched asymptomatic controls (<jats:italic>n<\/jats:italic>\u2009=\u200920). Means, standard deviations, 95\u2009% confidence intervals, mean differences and Cohen's <jats:italic>d<\/jats:italic> values were calculated for each variable for the MTSS symptomatic and control limbs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MTSS symptomatic limbs displayed a significantly smaller flexor hallucis longus cross\u2010sectional area, a smaller soleus thickness but a larger lateral gastrocnemius thickness than the control limbs. However, there was no statistical difference in lean lower leg girth. Compared to the matched control limbs, MTSS symptomatic limbs displayed deficits in maximal voluntary isometric contraction strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles, and reduced ankle plantar flexor endurance capacity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Differences in lower leg muscle structure and function likely render MTSS symptomatic individuals less able to withstand the negative tibial bending moment generated during midstance, potentially contributing to the development of MTSS. The clinical implications of these findings suggest that rehabilitation protocols for MTSS symptomatic individuals should aim to improve strength of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles along with ankle plantar flexor endurance. However, the cross\u2010sectional study design prevents us determining whether between group differences were a cause or effect of MTSS. Therefore, future prospective studies are required to substantiate the study findings.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13047-021-00485-5","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T08:02:49Z","timestamp":1625644969000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Lower leg muscle structure and function are altered in long\u2010distance runners with medial tibial stress syndrome: a case control study"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9550-7298","authenticated-orcid":false,"given":"Joshua","family":"Mattock","sequence":"first","affiliation":[{"name":"Biomechanics Research Laboratory University of Wollongong Wollongong NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie R.","family":"Steele","sequence":"additional","affiliation":[{"name":"Biomechanics Research Laboratory University of Wollongong Wollongong NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen J.","family":"Mickle","sequence":"additional","affiliation":[{"name":"School of Allied Health Human Services and Sport La Trobe University Melbourne VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,7]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"ClantonTO SolcherBW: Chronic leg pain in the athlete.Clin Sports Med1994 10.1016\/S0278\u20105919(20)30283\u201007805104"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","unstructured":"NewmanP WitchallsJ WaddingtonG AdamsR: Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta\u2010analysis.Open Access J Sports Med2013 10.2147\/OAJSM.S39331243797293873798","DOI":"10.2147\/OAJSM.S39331"},{"key":"e_1_2_12_4_1","unstructured":"MoenMH TolJL WeirA SteunebrinkM De WinterTC: Medial tibial stress syndrome a critical review.Sports Med2009 10.2165\/00007256\u2010200939070\u20100000219530750"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279\u2010013\u20100087\u20100"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","unstructured":"BurneSG KhanKM BoudvillePB MalletRJ NewmanPM SteinmanLJet al. 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