Leg Injury-Running

Abstract

HISTORY: 40 y/o male who complains of “cramping” of his left calf while running. Symptoms began approximately 3 years prior to evaluation and were intermittent at first, but progressively increased in frequency to the point where he could not run further than 2–3 miles before experiencing a “cramp” of his left calf. The cramps subside spontaneously with rest and stretching. He denies any temporal, environmental, or seasonal attributes to the cramps. The cramps are described as a “Charlie horse” of the calf. He denies any similar episodes in any other muscles of the legs or body at rest or with exertion. He also denies back pain, muscle weakness, sensory changes, bowel or bladder changes, skin temperature changes, nail or hair growth changes, skin color or texture changes, or cramping when at rest. The patient had seen multiple physicians previously, and work up (including DVT screen, angiogram, and MRI of the left calf) was negative to date. PHYSICAL EXAMINATION: Gait: Non antalgic, able to stand on toes without difficulty. Able to perform multiple single leg toe lifts without difficulty or asymmetry. Inspection: No muscle bulk asymmetry or atrophy noted. No cyanosis, hair pattern asymmetry, or nail texture asymmetry appreciated. No fasciculations noted. Bilateral pes planus noted. Palpation: No pain with palpation. No appreciable temperature difference between the bilateral lower extremities. No pain with palpation over the lumbar spine. Strength: Full strength with hip, knee, and ankle flexion and extension. Sensation: Intact to light touch and symmetrical to the bilateral lower extremities. Special Tests: Thomas and Obers positive bilaterally, Ely's was >12 inches bilaterally, popliteal angles were 60 degrees bilaterally, straight leg raise/seated straight leg raise/crossed straight leg raise negative for radicular symptoms bilaterally. DIFFERENTIAL DIAGNOSIS: “Runners Dystonia” of the left calf Chronic exertional superficial posterior compartment syndrome S1 radiculopathy Neurogenic Claudication TESTS and RESULTS: Previously ordered MRI of the Left lower leg, angiography, and doppler ultrasound for DVT negative for pathology. WORKING DIAGNOSIS: Runner's Dystonia TREATMENT: Enrollment in a physical therapy program utilizing judicious stretching and manual therapy of the lower extremities. Refrain from running pending course of physical therapy and functional retraining. FINAL OUTCOME: Pending