MEDIAL SHIN PAIN - RUNNER

Abstract

245 HISTORY - A 17 year old runner presented with a 4 year history of bilateral medial shin pain of insidious onset The pain, a constant ache, was initially felt only following activity, but progressed to become marked during running, walking and finally standing. There was associated lower back pain, the onset of which did not occur until [Illegible Text] after the prescription of orthotics 3 years following the initial onset of shin pain. She had been seen by a number of specialists including: Physicians, Orthopaedic surgeons and Rehabilitation physicians. The diagnosis had ranged from back related, to shin splints and compartment syndrome. She had undergone a number of conservative treatment regimes directed at both her shins and back, all for no improvement. PHYSICAL EXAMINATION - BACK-Full range of motion, Palpation revealed mild stiffness of her L4/5 and L5/S1 facet joints. There was no increased neuromeningeal tightness. LOWER LIMBS-Unstable forefoot valgus, Tight soleus apponeuroses, but no tightness of the deep posterior compartment. Pedal pulses were present in both plantarflexion and dorsiflexion. Examination post exercise, again revealed no tightness of the deep posterior compartments, presence of pedal pulses with the addition of bruits over the SFA. DIFFERENTIAL DIAGNOSIS: Vascular: Entrapment of the Popliteal or Superficial Arteries. Shin Splints(Tenoperiostitis) Deep Posterior Compartment Syndrome. Back: Spondylolisthesis at L5 on S1, resulting in a secondary spinal claudication. TESTS AND RESULTS: ANKLE BRACHIAL Index Test:RT Post. Tibial Artery Rest: 1.06 Post: 0.89LT Dorsalis Pedis Artery: Rest: 1.14 Post: 0.77Arterial Doppler US:Arterial compression with plantarflexion.Angiogram:High takeoff of the anterior tibial artery bilaterally;Occlusion of the popliteal arteries with plantarflexion. MRI of LumbosacralSpine.Gradel-2 Spondylolisthesis of L5 on S1, loss of disc space at L5/S1, Bilateral L5 nerve root entrapment. TREATMENT AND RESULTS: Bilateral Popliteal Artery Entrapment Release.-No Improvement.Neurosurgeon - Two Level Lumbar Fusion-L4/5 & L5/S1.-One month post surgery-A marked improvement.