Leg Pain In A Recreational Athlete - Page #1

Author: Elizabeth Barton, MD
Co Author #1: Matthew Baird MD
Co Author #2: Jenna L. Crowder MD
Co Author #3: Vicki R. Nelson MD PhD Irfan M. Asif, MD
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Jessica Knapp, DO

Patient Presentation:
25 year-old female graduate student presented to sports medicine clinic for left leg pain.

She described it as a "tightening" sensation in the lower leg while running associated with "foot drop" and swelling. It started a few weeks prior to presentation in the setting of running for the first time in years.
She otherwise reported a recent left ankle sprain in the month prior to re-starting running. She also described intermittent low back pain for > 5 years without radiculopathy.
Her past medical history was only significant for being overweight most of her life. She was not currently on any medications but had stopped using oral contraceptive pills approximately 1 year prior to presentation.
She was a non-smoker and a graduate student in athletic training. She grew up in geographically flat region, started running hills in last two years.
She had no significant family history.

Physical Exam:
Vital signs normal. Well appearing female.
Left leg inspection revealed increased size at thigh and calf compared to contralateral side. No discoloration. Trace non-pitting edema at lower leg. Full ROM of hip, knee, and ankle. 2+ DP/PT pulses. Left leg and foot cooler to touch compared to contralateral side. Pain to palpation of lateral and anterior lower leg. Compartments not tense. Diminished sensation to light touch of the entire left leg particularly over dorsolateral foot. Strength intact in hip, knee and ankle. 2+ Achilles and patellar reflexes. Normal gait. Heel and toe walk were normal.
Back exam revealed full ROM and was non-tender. Negative straight-leg raise bilaterally.

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