The legs of fifty cadavera were dissected to identify accurately the
structures that attach to the tibia at the site of symptoms of medial
tibial stress syndrome and that could potentially contribute to this
condition. The origins of the soleus, the flexor digitorum longus, and the
tibialis posterior muscles as well as that of the deep crural fascia were
measured. The average sites of attachment and the ranges of attachment were
determined for each structure. The soleus, the flexor digitorum longus, and
the deep crural fascia were found to attach most frequently at the site
where symptoms of medial tibial stress syndrome occur, while in no specimen
was the tibialis posterior found to attach at this site. The data support
recent reports that the soleus is probably the major contributor to
traction-induced medial tibial stress syndrome. The data also contradict
the contention that the tibialis posterior may contribute to this
particular condition.