Anterior Tibialis Muscle Herniation in a Pediatric Patient

Muscle herniations of the anterior compartment of the lower extremity occur when increasing compartmental pressure forms a fascial defect. This leads to severe pain in the region, preventing those affected from performing activities of daily living. Weak fascia can be congenital, or tears can come from direct trauma. Both can lead to muscle herniation. Anterior tibialis herniations are uncommon, and there is not much present in the literature documenting treatment for pediatric patients. Traditionally, young adult male athletes are most likely to develop this problem due to constitutional weakness of the fascia associated with overuse of the muscle, and penetrating or blunt trauma. [1] [2] The affected region can become painful with physical activity when the muscle herniates. If conservative treatments such as rest, physical therapy, compression (i.e. wearing compression socks) are not successful, patients are directed to surgical treatment. Three options of surgical treatment exist in the literature: fasciotomy, direct repair, or repair with synthetic grafts/mesh. The authors of this paper recommend performing a fasciotomy because this technique prevents the patient from suffering persistent compartment syndrome and negates the possibility of re-herniation. This case study discusses an 18-year-old female who experienced a muscle herniation in the anterior compartment of the right lower right extremity for which she underwent fasciotomy, and then had the same problem on the contralateral side also requiring surgical intervention. This case presentation adds to the literature as there is no visual surgical technique available for pediatric patients undergoing surgical treatment for muscle herniation. The patient is 18 years old, which is within the category considered pediatric by the American Academy of pediatrics and pain started at 16 years of age [3]. Additionally, the bilateral nature of the lower extremity muscle herniations makes this an especially unusual case.