Author: Jordan Orr, MD
Co Author #1: Adam Lewno, DO
Senior Editor: Carolyn Landsberg, MD
Editor: Jacob Miller, MD

Patient Presentation:
19 year old female collegiate and semi-pro soccer player with three year history of progressive bilateral exertional leg pain

History:
The patient reported bilateral lower extremity pain and paresthesias extending down her posterior and lateral legs to the plantar foot. This occurred after 15-20 minutes of soccer activity and rapidly improved after stopping running. It was possibly accompanied by foot weakness. She denied symptoms while weight training or biking. She performed no additional training outside of soccer. She had no change in her cleats or shoes and denied a change in playing surface. She denied any trauma, skin changes, tripping/falling, increased pain along her lateral calf, ankle swelling, bulging, or focal throbbing of tissues. She performed physical therapy with her athletic trainer without improvement. She tried ibuprofen, gel cups, and shoe inserts without relief. She denied any lower extremity surgeries, injections, chiropractic care, massage, acupuncture, or cupping. Chronic exertional compartment syndrome testing performed previously was negative, but she did not reach her normal level of pain during the test. She had no significant past medical or surgical history, used no medications, and had no allergies. She had a family history of Factor V Leiden in her mother, maternal aunt, and maternal grandmother.

Physical Exam:
Vitals: Blood pressure 127/66, heart rate 75, body mass index 22.07. General: No acute distress, well developed. Respiratory and Cardiovascular: within normal limits. Neuromuscular: Full active range of motion of bilateral hips, knees, and ankles. 5/5 strength in lower extremities. Sensation to light touch grossly intact over L2 to S2. Proprioception intact at great toes. Reflexes: 2 plus and symmetric at Patellar and Achilles tendons. Gait: Without abnormality, neutral hind foot with mild flexible pes planus. Focused lower limb exam: No swelling, erythema or ecchymosis. Popliteal space without palpable cyst or mass. No tenderness to palpation of foot, distal leg, or ankle structures. Slight decrease in dorsalis pedis pulse during dorsiflexion in knee extension. Otherwise, no change in dorsalis pedis or posterior tibial pulses during dorsi or plantarflexion when performed in full knee flexion. Negative Tinel's at the fibular head bilaterally, normal fibular head motion bilaterally.

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