Missing the Bull’s Eye: A Case Report of Tibialis Anterior Hernia

Shin pain is a broad term used to describe lower leg pain. It is commonly seen in the athletic/sports population. Various conditions have been claimed to produce leg pain, and muscle herniation is one of these conditions. Muscle herniation is the protrusion of muscle through a defect in the overlying fascia. Although such herniation is common, it is often an underdiagnosed condition in the lower extremity. It usually occurs in athletes, especially in the anterior compartment of the leg, as a result of trauma or due to muscle hypertrophy secondary to strenuous exercise. Herniation diagnosis depends on its clinical presentation as it appears as a palpable soft tissue bulge through a fascia defect; radiological findings are used to confirm the diagnosis. Conservative treatment should be the initial approach, and surgery can be performed if conservative treatment fails.

We present a case of symptomatic anterior lower leg pain, initially diagnosed as a psychosomatic disorder by two orthopedic physicians. However, tibialis anterior hernia in this patient was confirmed after physical examination by a physiotherapist and subsequent referral for ultrasonographic evaluation to a radiologist. The patient underwent an 8-week course of conservative treatment under the supervision of a physiotherapist. This treatment significantly improved the patient’s pain and function.

After eight weeks of conservative treatment using Minhaj protocol for Tibialis Anterior hernia, the patient has reported improvement in pain (reduction of score from eight to two on the NPRS scale) and function. The patient returned to his previous level of physical activity following eight weeks of rehabilitation.

Tibialis anterior hernia should be considered a differential diagnosis in chronic leg pain with palpable soft tissue protrusion. Conservative treatment can be chosen as the primary approach.