Author: Daniel Clearfield, DO, MS
PB is a 47 year old long distance runner and triathlete who presents with complaints of bilateral calf pain while running. The pain started roughly two months prior to presentation and had an insidious onset. He describes it as excruciating pain that starts when he is about 4 miles into a run and escalates with continued activity. The pain diminishes with walking and goes away shortly after cessation of activity.
PMHx: PB is a 47yo Caucasian male, no chronic medical conditions
Surgical Hx: none
Past orthopedic problems: occasional ankle sprains while competing as Division I collegiate wrestler, never required surgical intervention. No history of fracture or stress fracture
Activity level: he typically runs ~30 miles/week and cross-trains with cycling and swimming; he was training for a half-marathon at presentation to our clinic
General, HEENT, cardiovascular, respiratory, abdominal, and neurovascular exams all WNL
Lower extremity strength, range of motion, and sensation were all WNL
Structural exam of the lower extremities: tight heel cords bilaterally bilateral navicular drop with calcaneal valgus, myofascial restriction notably in right anterior compartment and in left deep posterior compartment, no fascial herniations noted
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.