Lower
leg pain
Lower leg pain is a common complaint in athletes who have recently
changed their footware or have increased the intensity of their training. The
main diagnoses to be considered are stress fracture of the tibia, chronic
compartment
Stress fractures are not uncommon in the tibia, particularly in
long-distance runners. The patient initially complains of pain during exercise,
then pain during arid after exercise, and finally pain at all times. On
examination there may be little to find except that the tibia may he tender to
percussion. Initially the X-ray may he normal but after some weeks a faint haze
of callous may form locally over the site of the invisible fracture. This X-ray
picture, if combined with a history of continuous pain, is also characteristic
for osteosarcoma. Careful imaging with MRI or CT scan should be able to
distinguish between these two diagnoses.
This
condition can prove very difficult to manage. It may occur at a crucial phase in
an athlete’s training programme and at some stage, preferably sooner rather
than later, it is going to become clear that training for the next few months
Chronic
compartment syndrome
The anterior and deep posterior compartment is most commonly involved.
Physicial examination is generally unhelpful and a diagnosis is made from the
history and intracompartmental pressure monitoring whilst the athlete
exercises. Subcutaneous fasciotomies of the affected compartment provides good
relief of symptoms.
Tibialis
anterior syndrome
Acute inflammation in the tendon sheath of the tibialis anterior muscle
often arises from over-use of the ankle joint, especially running and jumping on
hard surfaces. Tenderness is localised to the tibialis anterior tendon with pain
on resisted dorsiflexion of the ankle. Increased temperature, swelling and
crepitus may be palpated over the tendon sheath. Resolution is usually swift
with a short period of nonweight-bearing and rest.
Medial
tibial periostitis
The attachment of the investing muscle fascia into the periosteum of the
posteromedial order of the tibia may become inflamed. The pain is often poorly
localised by the athlete but tenderness is well localised over the distal medial
margin of the tibia, particularly over the lower half of the bone. Resisted
plantar flexion aggravates the pain and radiographs should be performed to
exclude a stress fracture.