The much larger gastrocnemius and soleus muscles pull the forefoot down. The tremendous stress of eccentric contractions can damage the anterior compartment muscles. Symptoms, Signs, and Diagnosis Pain in the anterior compartment muscles starts immediately after the heel strikes the ground during running. If running is continued, the pain becomes constant. By the time advice is sought, severe point tenderness usually is present over the anterior compartment muscles.
Diagnosis is based on the symptoms and signs.
The posteromedial compartment muscles supinate the foot and raise and evert the heel just before toeing off. Excessive pronation causes the arch to drop lower than normal, increasing the force necessary to lift the arch during supination. With continued running, the pain may progress into the muscles. Traction on the tibialis posterior can lift the muscle from its bony origin, causing subperiosteal hemorrhage and periostitis. With continued traction, part of the tibia can be torn away.