A Not So Simple Case Of Chronic Leg Pain - Page #1
 

Author: Calvin Luu, DO
Co Author #1: Joshua Blomgren, DO
Senior Editor: Siobhan Statuta, MD, FAMSSM
Editor: Heather Rainey, MD

Patient Presentation:
A 22 year old male presented with a five year history of chronic exertional bilateral leg pain.

History:
This young patient was diagnosed with chronic exertional compartment syndrome of the left leg in March 2019. At that time, he could only walk 20 minutes before developing pain and muscular bulging of his left shin. He underwent anterior and lateral compartment fasciotomy of the left leg and was noted to have two fascial herniations similar to those noted pre-operatively. Similar symptoms then developed in the right leg and compartment pressure testing was performed. Pressures were greater than 50mmHg in the anterior and lateral compartments after five minutes of walking. In February 2020, he underwent a four compartment fasciotomy of the right leg. Post-operative physical therapy was cut short by the COVID-19 pandemic and symptoms continued despite surgical release. At that time, symptoms were occurring in both legs after 10 minutes of walking or five minutes of running.

Physical Exam:
The patient walked with a non-antalgic gait. Well-healed surgical scars were noted on bilateral lower extremities. The right anterior lower leg had an apparent fascial herniation, with some tenderness to palpation at distal anterior and medial tibia. Range of motion of bilateral lower extremities revealed pain-free dorsiflexion to 25 degrees, plantarflexion to 50 degrees, inversion to 20 degrees, eversion to 5 degrees. On strength testing, there was 5/5 resisted plantarflexion, dorsiflexion, inversion, eversion, great toe flexion and extension, all without pain. Sensation was intact bilaterally. Patellar and Achilles reflexes were 2+ and symmetric. Dorsalis pedis and posterior tibial pulses were 2+ bilaterally.

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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