Posterior Distal Lower Extremity Pain: A Case Report - Page #1
 

Author: Alexander Senk, MD
Co Author #1: Aaron Vaughan, MD Department of Sports Medicine, Mountain Area Health Education Center, Asheville, NC.
Editor: Matthew Cameron, DO

Patient Presentation:
44-year-old male presented with complaints of discomfort along the posterior aspect of his distal right lower extremity. It began acutely after feeling a popping sensation when running about 1 year ago. He experienced an initial burning pain that gradually became a numb discomfort extending to his lateral right ankle. His symptoms were recalcitrant to the use of foot orthoses, application of heat and ice, over-the-counter topical analgesics, and consistent heel cord/calf stretching. He was most concerned as he has recently appreciated a focal area of swelling that coincides with his area of maximal discomfort.

History:
His past medical history is remarkable for hypertension, stage II chronic kidney disease, and possible congenital polycystic kidney disease.

Physical Exam:
General: Well-nourished African-American male in no acute distress.
Psychological: Pleasant, cooperative, and insightful with warm affect and congruent mood.
Respiratory: Unlabored respirations at rest, speaks with ease, no audible wheezes.
Cardiovascular: Distal pulses intact with warm, well perfused extremities without edema.
Musculoskeletal: Tender small 1-2 cm cystic structure with focal swelling approximately 4 cm proximal to calcaneal insertion. No surrounding erythema or warmth. 5/5 strength and full painless active range of motion throughout the right lower extremity. No pain with loading of the gastrocnemius/soleus complex.
Neurologic: Oriented in all spheres. Steady gait with normal base of support. Normal sensation to light touch and proprioception. Positive Tinel's with symptom reproduction over the cystic lesion.

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