Objectives: 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. Methods: 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. Results: 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. Discussion: 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.

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Background: Chemoradiation plays an important role in cervical cancer treatment but dose to organs at risk (OAR) is the limitation while escalating dose to target. With conformal techniques dose escalation is made possible without increase in toxicities. Though node positive cervical cancers have poorer prognosis delivering higher dose to the involved nodes have shown benefit. We aim to determine the patterns of failure in node positive cervical cancer patients treated with chemoradiation and to determine the grade III and IV toxicities associated with it.Methods and Materials: In this retrospective study node positive cervical cancer patients treated with conformal radiotherapy were analysed. 45 Gy -50.4 Gy was given to the pelvis and 55 Gy to positive nodes with sequential or simultaneous integrated boost (SIB) in 25 -28 fractions with weekly cisplatin 40mg/m2 followed by brachy therapy. Extended fields were used to treat patients with positive para aortic lymph nodes. Treatment toxicities were recorded as per CTCAE version 4.3. Results: Of the 62 patients 87.1% had squamous cell carcinoma and majority were in stage II (38.7%). At a median follow up of 33 months two (3.2%) patients had local recurrence, eight (12.9 %) had distant failure and one (1.6%) had loco regional recurrence. Lung was the most common site of metastasis followed by the supraclavicular region. The 3 year overall and disease free survival were 91.4 % and 77.2 % respectively. Stage of the disease (p=0.001) and residue at the end of therapy (p-0.010) showed significant association with DFS but not with OS. 21 (33%) had Grade III –IV toxicities, nine (13%) having acute toxicities and 12 (19.4%) had late toxicities. Conclusion: Though node positive cervical cancers have poor prognosis our study showed that aggressive management improves the outcome without increase in toxicities.