EXERTION CALF PAIN - HEPTATHELETE

Abstract

243 HISTORY - A 21-year-old female collegiate heptathelete developed bilateral calf pressure and tightness while running. During her daily training sessions she would develop the symptoms of bilateral calf pressure and tightness after running about one mile. She denies any paresthesias or cool lower extremities. After slowing to a walk for 10-30 seconds she could resume running for another mile before her symptoms developed again. Repeated treatments with ultrasound, massage and whirlpool after training sessions did not improve her symptoms. After the season ended she went to military officer candidate school but was discharged after three weeks due to the development of the same symptoms. PHYSICAL EXAMINATION - Examination revealed lower extremities which were bilaterally symmetric and well developed with no discoloration, abnormal skin changes or palpable point tenderness. Motor strength and sensory function was normal and symmetric. Homan's sign was negative. Posterior tibial and dorsalis pedis pulses were not palpable on the right; both were weakly palpable on the left. DIFFERENTIAL DIAGNOSIS: Chronic compartment syndrome Bilateral popliteal artery entrapment Medial tibial stress syndrome/stress fracture TEST AND RESULTS: Bilateral lower extremity angiogram - bilateral-lateral deviation of the popliteal artery at the level of the femoral condyles with extrinsic compression when the patient plantarflexes her feet causing near complete occlusion of the vessels; right greater than left FINAL/WORKING DIAGNOSIS: Bilateral popliteal artery entrapment TREATMENT: Surgical exploration of the right lower extremity showed an accessory slip of the medial head of the gastocnemius compressing the popliteal artery which was ligated. Three weeks later the same procedure was performed on the left. Postoperatively the patient was showing good response to physical therapy and rehabilitation.