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Poor Perfusion Or Elevated Pressures? An Exertional Lower Limb Pain Conundrum - Page #1
 

Author: Ana Capati, MD
Co Author #1: Michael Bolton, MD
Co Author #2: Soren Estvold, MD, MPH, CAQSM
Co Author #3: Alexander Knobloch, MD, CAQSM, FAAFP
Senior Editor: Drew Duerson, MD
Editor: Charles Litchfield, MD

Patient Presentation:
A 35-year-old active duty U.S. Air Force male presented to clinic with a six-year history of right lower extremity pain and tightness while running and walking.

History:
His pain was localized to his posterior right lower leg, described as a tightening and burning pain that started a few minutes into his runs or with prolonged walking. There was no preceding increase in activity level and no history of recent trauma to his lower leg. He denied numbness, tingling, weakness, or skin changes of the lower leg, ankle, or foot before, during, or after exertion. He had no sustained relief with physical therapy. He otherwise did not have any cardiovascular or metabolic disease and no significant family history, and he denied tobacco use.

Physical Exam:
He was healthy appearing, in no acute distress, with a non-antalgic gait. Subtle atrophy of the right calf was noted. There was no ecchymosis, skin lesion or discoloration, deformity, pes planus, or pes cavus. His lower extremities were warm and well perfused, without edema. There was no bony or soft tissue tenderness. Ankle and knee ranges of motion were normal. Strength was full at the ankle and foot, and sensation to light touch was intact and symmetric bilaterally. Posterior tibial and dorsalis pedis pulses were symmetric with normal pulse strength. Pain was not reproduced with walking on toes in the exam room or repeated standing heel raises.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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

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