25 Year Old With Exertional Calf Pain - Page #1

Author: Andrea Aagesen, DO
Co Author #1: Jeffrey Housner, M.D. University of Michigan Health System Department of Orthaepedic Surgery
Co Author #2: Robert Kiningham, M.D. University of Michigan Health System Department of Family Medicine

Patient Presentation:
A twenty-five year old man presented to Sports Medicine clinic for left posterior calf pain of two years duration.

The patient initially developed cramping pain in the deep calf region while swimming with flippers in the ocean over two years ago. Since that time, pain has occurred in his deep calf and anterior ankle upon onset of exercise or exertion, particularly recreational running. The pain is often preceded by intermittent numbness in the first web space. He has no symptoms at rest. He has noticed a slight intermittent discoloration of his toes on the left foot. He does not recall any specific injury or trauma.

Prior interventions included physical therapy for calf strain, orthosis, and NSAIDs with minimal improvement. Prior magnetic resonance imaging was negative.

Past Medical History: Attention Deficit Hyperactivity Disorder
Past Surgical History: negative
Allergies: NKDA
Medications: Adderall
Social History: former smoker with occasional alcohol use.
Family History: noncontributory

Physical Exam:
There is no muscle atrophy, swelling, or asymmetry. Compartments are soft and supple without palpable masses or nodularity. There is subtle paleness of the skin on the left foot compared to the right. Tenderness could not be reproduced with palpation, including the region of reported pain deep to achilles tendon. Full, pain free knee and ankle range of motion is present. Strength is 5/5 on manual muscle testing without reproduction of pain. Deep tendon reflexes are 3+ at achilles and patella. Negative straight leg raise bilaterally is noted. Sensation is intact in the L3-S2 dermatomes bilaterally. Left pedal pulse slightly diminished.

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