Author: Abiye Ibiebele, MD
Co Author #1: Christopher Hogrefe, MD, FACEP
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Heather Rainey, MD

Patient Presentation:
37 year old male who presents with left sided calf and tibia pain which began while playing a game of basketball.

History:
A 37 year old male presented to the Sports Medicine Clinic for evaluation of his left calf pain. He had been assessed by another provider three months prior for pain that began during a basketball game. His pain was located along the medial and lateral left calf, with lesser discomfort in the shin. It was sharp, burning, non-radiating, and 5/10 in severity. He had not experienced similar pain in the past. He denied back pain or right lower extremity pain. He denied numbness, but did endorse that his foot intermittently fell asleep, though this mostly happened when he was sitting. An MRI after his initial visit revealed a possible fibula stress reaction and a grade I hallucis longus muscle strain. He had been prescribed a walking boot and eight weeks of physical therapy. Upon reassessment, he reported persistent symptoms. He noted the pain was exacerbated by walking and relieved by rest. He had not returned to baseline with physical therapy, and pain did not improve with NSAIDs.

Physical Exam:
Visual inspection of the back and left lower extremity was unremarkable. Palpation of the left lower extremity revealed tenderness to palpation at the mid-popliteal fossa and over the medial and lateral gastrocnemius. Back flexion, extension, and rotation were full and painless. Left knee flexion and extension were full and painless. Left ankle plantar flexion, dorsiflexion, inversion, and eversion were full and painless. Resisted range of motion of the left knee and ankle were painless. Seated slump test and straight leg raise were negative. Provocative testing of the knee was unremarkable. Deep knee flexion, duck walking, and hop testing were unremarkable. Neurovascular exam was unremarkable.

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