The anterior compartment muscles (tibialis anterior, extensor hallucis longus and extensor digitorum longus) hold the forefoot up during foot descent and contract eccentrically immediately after the heel strikes the ground. They are opposed by the much larger gastrocnemius and soleus muscles, which pull the forefoot down. The tremendous force of eccentric contractions can damage the anterior compartment muscles
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Pain occurs in the anterior compartment muscles, at first only immediately after the heel strikes the ground during running. If running is continued, the pain will occur throughout each step, eventually being felt constantly. By the time advice is sought, there is usually severe point tenderness over the anterior compartment muscles.
Treatment includes stopping running, trying an alternate exercise, stretching the calf muscles, and doing exercises to strengthen the anterior compartment muscles after they start to heal.
The main function of the posteromedial compartment muscles is to supinate the foot and raise and evert the heel just before "toeing off". Increased traction on the muscles is caused by excessive pronation and by running on banked tracks or crowned roads (exacerbated by wearing shoes that do not effectively restrict pronation). Excessive pronation causes the arch to drop lower than normal, increasing the force necessary to lift the arch durig supination.
Pain usually starts in the postremedial compartment muscles; 2 to 20 cm above the medial malleolus. It becomes more severe when the athlete rises up on his toes or everts the foot. If he continues running, the pain then moves forward to involve the medial aspect of the tibia, and can then move up the medial side of the tibia, to reach within 5 to 10 cm of the knee.
Pain location and severity depend on injury progression. First, there is a tendinitis of the muscles of the deep posterior compartment. If the athlete continues to run, the pain may progress into the muscle bodies themselves; then traction on the tibialis posterior tendon can lift the muscle from its bony origin, causing subperiosteal hamorrhage and periostitis. With continued traction, part of the tibia can be torn away.
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