Leg Pain in a 23 Year Old Football Player

Abstract

HISTORY: A 23 year old male reported getting kicked in the leg during a collegiate football game. He noted immediate pain in his lateral calf after attempting a tackle. He did not feel or hear a pop. He had a noticeable limp walking off the field. There was no pain in the ankle or foot, but he noted pain with ankle movement. He had pain with weight-bearing but denied any numbness or tingling. The next day, he developed worsening pain that was unbearable with any change of position or movement. The pain was greatest along the mid-lateral leg but extended along the entire leg anterior and laterally. He had limited ability to move his toes and foot which was a new symptom. PHYSICAL EXAMINATION General: Alert and oriented in mild distress at rest. Left leg Edema: Anterior and lateral leg without pitting. Compartments: Diffusely tender but not tense. Tenderness: Diffuse, anterior and lateral compartments more than fibula and posterolateral. Range of motion: DF 0 degrees, PF 30 degrees. Pain was worse with initiation. He tolerated gradual passive stretch of the anterior, more than the lateral. Pain with inversion and eversion . Strength: 1/5 anterior tibialis, EHL, EDL, Peroneals with pain, 2/5 GS/PT with pain. Neurovascular: Intact, 2+ PT/DP pulses, cap refill < 2 sec. DIFFERENTIAL DIAGNOSIS 1. Gastrocnemius Strain 2. Compartment Syndrome 3. Popliteus Strain 4. Fibular Fracture 5. High Ankle Sprain TESTS AND RESULTS XRays 1. Fluoroscopic imaging of the tib-fib and ankle were negative. 2. Tib-fib and Ankle xrays were negative for fracture and stress view demonstrated stable joint. Compartment Testing Diastolic pressure: 74 Left lower leg anterior compartment: 20 Left lower leg lateral compartment: 28 Left lower leg posterior superficial compartment: 27 Left lower leg posterior deep compartment: 26 MRI 1. Nondisplaced fracture of the middle third of the fibula. 2. Acute grade 1 muscular injury of the peroneal muscles of the lateral compartment. FINAL WORKING DIAGNOSIS Midshaft fibular stress fracture TREATMENT AND OUTCOMES 1. Patient was admitted to the hospital for observation for one night. 2. Patient was discharged and allowed to weight bear as tolerated in the tall CAM boot for two weeks. 3. At two weeks, he was weaned out of the boot and allowed to progress into activities. 4. At six weeks, he was participating in football without any limitations.