Never seen before – by me at least

Tibialis Anterior

Today in the office I saw a very interesting case.  I know what it was easily, but it was something I had never seen in 30 years of practice. The patient was a 61 year old gentleman who had taken a very long walk, maybe 10-15 miles, two weeks ago, and had noted pain and swelling over the lower front of the leg and ankle.  It has continued to hurt for 2 weeks, and he came to see me because he is going on a mission trip in a few days, and is concerned it will be a problem there.  On exam he was quite swollen over the tendon sheath of the muscles that pick up the front foot (the tibialis anterior tendon sheath for you anatomy geeks) and had crepitas (a creaking feeling when I felt over the tendon sheath).  We often see this in the wrist and forearm after a weekend of hard work in the yard or other unusual activity, but it is much less common in the leg.  I found a nice article on it using Dr. Google on Sports Injury Clinic on the Net.  Fun to have a first time case every now and then, especially one I can diagnose, and when the prognosis is good.