A Not So Classic Case Of A Tibial Pain In A Distance Runner - Page #1

Author: Cameron Allen, B.S.
Co Author #1: Brandon Motzel, B.A. A.T. Still University of Health Sciences Kirksville College of Osteopathic Medicine
Co Author #2: Kevin Marberry, M.D. A.T. Still University of Health Sciences Kirskville College of Osteopathic Medicine, Department of Surgery
Editor: Margaret Gibson, MD
Senior Editor: Margaret Gibson, MD
Editor: Siobhan Statuta, MD
Senior Editor: Margaret E. Gibson, MD

Patient Presentation:
A 20 year old male patient presented with left posteromedial calf pain first noticed during running that would resolve spontaneously with rest. The pain was characterized as a sharp, stabbing sensation that was consistent with every run. Additionally, the patient noted a bump on the proximal medial aspect of the tibia. The patient was otherwise healthy and denied joint pain, cramps, stiffness or other associated symptoms.

This patient was a 2nd year student at a local university. He had previously run cross country and track during high school, but had been away from running for 2 years since graduating. However, he recently resumed running several months ago about two or three times per week, and distances up to three miles at a time. His current running shoes were purchased recently and were a model similar to those he had always worn for running.
His past medical history and family history were unremarkable.

Physical Exam:
On physical examination of the knee, there was no extra-articular swelling or effusion noted. Tenderness to palpation was present at the proximal medial tibia and a 2 cm nodule was also noted here, about 7 cm distal to the joint line. Knee range of motion and stability was normal bilaterally. Normal strength was noted and no gait abnormality or joint malalignment was present.

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