Clinical review of patients treated for atypical claudication: a 28-year experience

Abstract

Purpose This article describes patient demographic data, as well as diagnosis and treatment of symptomatic lower extremity claudication that has no apparent vascular or orthopedic cause. Methods A retrospective review was performed of records for 843 patients who received surgical treatment between 1975 and 2003. All patients had a detailed history, and underwent physical examination and selected noninvasive vascular testing. Noninvasive popliteal entrapment screening tests and compartment pressure measurements for isolated superficial muscle pain were routine. Duplex scanning or arteriography were used only when arteriovenous disease or popliteal entrapment syndrome was suspected. Results The study population included 549 female patients (65%) and 294 male patients (35%). Their mean age was 29 years (range, 12-71 years). The most common symptoms were isolated lower extremity muscle cramping (100%), foot paresthesia (20%), and medial tibial bone pain (1%). Causes of symptoms included chronic compartment syndrome (796 patients, 94%), functional popliteal entrapment syndrome (33 patients, 4%), and medial tibial syndrome (14 patients, 2%). Pathologic findings included overuse injury (756 patients, 89%), blunt limb trauma (60 patients, 7%), or gait anomaly (34 patients, 4%). Surgery for compartment release included fasciotomy (100 patients, 12%) or fasciectomy (696 patients, 88%). Surgery for functional popliteal entrapment included excision of the plantaris muscle and soleal band (33 patients). Medial tibial release included soleal and transverse fasciectomy, with periosteal cautery of the tibial insertions. Complete symptomatic relief was achieved in 92% of compartment release procedures, 100% of popliteal entrapment release procedures, and 80% of medial tibial release procedures. Conclusion Atypical claudication represents a collection of syndromes that can be permanently and effectively treated with surgical intervention.