A 15-year-old football player presented with a 3-day history of pain over the mid-tarsal region of the foot, without history of an acute trauma. The pain was not related to walking or running and was only present when kicking the ball.
The most significant examination finding was of tenderness to palpation over the tibialis anterior tendon and the distal portion of the tibialis posterior tendon. Resisted contraction tests of these tendons was also painful.
An x-ray series of the foot and ankle was normal. MRI showed soft tissue oedema between the distal anterior tibialis tendon and the medial cuneiform and navicular bones consistent with bursitis. There was no other significant structural pathology.
The patient was treated with a short period of rest combined with regular icing, regular NSAID and progressive rehabilitation.
The tibialis anterior tendon bursa is located between the tibialis anterior tendon and the medial cuneiform bone, close to the tendon insertion. Bursitis can occur as a result of excessice local friction, infection, arthritis, or direct trauma. This condition can be difficult to diagnose as it mimics several periarticular and muscle lesions. However, imaging findings of bursal fluid distension should make for a clear diagnosis. Note that the sub-tendinous location of the bursa and a partial inferior fluid involvement of the tendon are key for differentiating from tenosynovitis. In the vast majrity of cases this condition settles spontaneously. In rare cases, endoscopic resection of the bursa can be performed. This would only be indicated when there is a symptomatic bursitis that does not respond to conservative treatment or when infection is suspected.
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