LEG PAIN: FOOTBALL 173

Abstract

HISTORY - A healthy, twenty year old football player presented with complaints of bilateral leg pain during “two-a-day” fall practices. The pain began insidiously while training two months previously with no trauma. The pain initially occurred after running but now interfered with all drills. He had no paresthesia, weakness, hip pain or back pain. The pain was diffuse but primarily lateral and posterior in his mid-calf. Initial treatment with ice and NSAID's was unsuccessful and he had to discontinue participation. PHYSICAL EXAMINATION - The patient could walk without a limp and had no deformity or swelling. Walking on his toes aggravated his pain. He was entirely neurologically intact to sensory, motor and reflex testing. His compartments were soft but he was tender over the mid-portion of his lateral compartment near the fibula in both legs. He had no ankle swelling or tenderness. He had no pes planus or foot abnormalities. DIFFERENTIAL DIAGNOSIS: Bilateral compartment syndrome Bilateral stress reaction or fracture Gastrocnemius cramps or strains TEST AND RESULTS: Plain radiographs tibia-fibula: normal Three phase bone scan: bilateral mid-shaft fibula stress fracture FINAL DIAGNOSIS: Bilateral mid-shaft fibula stress fracture TREATMENT: Weight bearing as tolerated-no running. Aerobic training with cycling, pool running. Return to football six weeks later.