Atypical Presentation Of An Uncommon Cause Of Lower Leg Pain - Page #1

Author: Drew Duerson, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Michael Moreland, DO

Patient Presentation:
14-year-old male presented to sports medicine clinic with insidious onset lower leg pain.

A 14-year-old male presented with lower leg pain for approximately 2 weeks. He denied any recent trauma or a clear mechanism of injury but did recall a recent worsening of pain after jumping on a trampoline. He was not otherwise active in sport or exercise. For the past few days he described constant pain, including pain waking him from sleep. He had difficulty full weight bearing and walked with a limp. He denied fevers, chills or weight loss. He described progressively worsening calf swelling without ecchymosis. He denied insect bites, abrasions, or rash. There were no dietary concerns per the family. He had no prior history of lower leg pain.

Physical Exam:
Patient was healthy appearing and in no apparent distress. He was afebrile. He ambulated with a limp and an externally rotated right lower leg. He was unable to single leg hop. There was focal swelling at the proximal lateral compartment of the lower leg. There was no ecchymosis or erythema. There was tenderness along the proximal fibula, peroneus longus, and soleus muscles. This area was also slightly warm to touch. There was full ankle and knee range of motion, but pain was recreated with resisted eversion and plantarflexion. Pain was present with passive ankle dorsiflexion.

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