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.

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.

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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