Archive for the ‘Shin Splints’ Category

Custom Functional Orthotics

Custom orthotics are the best decision people can make to improve their foot health and function. Custom orthotics are unique and specially made to your feet.  Orthotics treat and correct individual foot ailments. Proper shoes fitted with custom foot orthotics are the best insurance that we can give ourselves to protect our feet.

Your orthotics are manufactured by a state-of-the-art fabrication facility utilizing the latest advancements in machinery and technology available today.  The fabrication starts with an analysis of your feet and a laser casting.  The image produced from this scan is sent to our lab where your device is “born”.  The technicians analyze these scans and make subtle adjustments to ensure a precise fit and form. Exact models of your feet are created on an automated CAD/CAM milling machine.  These models are used to form your orthotics with a high temperature pressure fit system.  Then they are assembled by hand and laminated.  The result is a set of orthotics made to your feet with Dr. Murray’s or Dr. Chang’s specific instructions and modifications to optimize your foot function.  This process typically takes 2 weeks and you will be called when they are ready.

Please bring the shoes you plan on using the orthotics with so one of our assistants can check for a proper fit. You will be given instructions to use with the orthotics during the “breaking-in” period. A follow up appointment will be made to discuss with the doctor how the orthotics are working for you. Some patients may need more time to get used to their orthotics and some orthotics may require adjustments.  Although most patients are happy with their devices immediately, we want you to appreciate the uniqueness of the human body and understand this process can sometimes take time to make the proper adjustments. Our goal is to help treat and correct your ailment so you can live a healthy and active lifestyle. Therefore, we include free adjustments for 90 days.  

One set of orthotics may suffice for many of our patients, but different activities require different accommodations. Therefore, some of our more active patients order multiple pairs of orthotics. Here are a few of the reasons why:

Custom Orthotics by Blue Ridge Foot and Ankle Clinic

Blue Ridge Foot and Ankle Clinic Custom Orhotics

I need a second set of orthotics for when my other pair gets wet.” – Local runner

I need orthotics for standing on a concrete floor all day and another pair for hiking with my family.” – Factory worker

My orthotics really help in my athletic shoes. I wish they worked in my dress shoes.” – Local business woman (we offer the Cobra, which is an orthotic designed to work with many casual and dress shoes)

Most of our orthotics are designed to last 5 to 10 years. Depending on your particular ailment, activity, and amount of use, your orthotics may need to be refurbished (re-covered) during this time period.

Cost:

First set – $395.00

Additional set – $300.00

Refurbishment – $75.00

These are the prices for non-covered orthotics; when covered by insurance, the prices are predetermined by the terms of the insurance plan.

Insurance coverage: Please verify with your insurance company that custom orthotics are a covered benefit and how your deductible and coinsurance apply.

Welcome to the Blue Ridge Foot and Clinic team. We look forward to helping you stay healthy and active.

 
Blue Ridge Foot and Ankle Clinic
 
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887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
New office in Fishersville will open early 2015 @
66 Parkway Lane Suite #102
Fishersville, VA 22939
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
rsz_running_card

 

Why Do My Shins Hurt?

August 6th, 2014 by Dr.Chang

Shin Splints

Shin splints, also called tibial stress syndrome, are a common complaint of runners who increase their mileage or intensity too quickly. Feeling throbbing or aching in the shins is surprisingly common for athletes and runners. Shin splints, howevShin Splintser, aren’t a single medical condition. They can be caused by a number of factors; irritated and swollen muscles, over use, stress fractures, over-pronation or flat feet, and running on hard surfaces, to name a few. With shin splints you will feel a dull and aching pain in the front of the lower leg during exercise, or even after exercise. Shins may be painful to the touch, muscles can swell, and nerves can even be affected causing parts of the feet to go numb.

There are various places where the shin can cause pain. Usually, a flatfoot can cause pain in the tibialis posterior, or the front and outside of your shin. High arches can cause anterior lateral shin splints, on the inside of your shin. Less common is pain deep in the back
of the leg, caused by tightness in your inner calf muscles, the soleal complex. No matter what kind, shin splints are a mechanical issue, caused by excessive mileage and a pounding stride.

There is good news for all of you who suffer from shin splints: they are very treatable, with quite high success rates! So have hope as you begin your treatment plan. Treatment for shin splints varies according to the nature of your own individual injury. In general, the very first thing to do is to rest in order for your injury to heal. Additionally, ice, NSAIDs, arch supports, range of motion exercises (as recommended by your podiatrist or physical therapist), a neoprene sleeve to support and warm the leg, and physical therapy will be recommended. If your shin splints are caused by stress fractures, you may be put in a walking boot or even need surgery for severe cases.

Remember that recovering from shin splints can be a frustratingly long process. Many runners need up to six months, or more, to recover. Resist the urge to start running again before you are ready, because your injury could become more severe. To bide time and to stay in shape until you heal, you can take up activities that have little impact on your legs such as swimming or cycling. You will know when you are ready to run again by a number of factors including equal flexibility in your legs, activity does not cause pain, or when x-rays show that your stress fractures have healed. To avoid shin splints wear good shoes with the right amount of support for your foot, warm up and then stretch before working out, run on soft surfaces, and stop working out when you feel pain in your shins.

CALL US TODAY FOR AN APPOINTMENT.  WE ARE ACCEPTING NEW PATIENTS.

Request a copy of our FREE book from our home page: www.brfootandankle.com

Blue Ridge Foot and Ankle Clinic
887 A Rio East Court
Charlottesville, VA 22901
434-979-8116
&
417 South Magnolia Dr
Waynesboro, VA 22980
540-949-5150

On Saturday (bright & early in the morning!) Dr. Chang  spoke to Charlottesville Women’s 4 Miler Training Program participants about how to maintain healthy feet & ankles while training for the race coming up this Fall. His main piece of advice for them was to be sure they rest.  Their training schedule gives them a ‘day off’ on Fridays and he asked that they stick to that so their body can recover and remain injury free.  After their training run, many of the ladies came to Dr. Chang for advice on foot and ankle issues that they are already experiencing.  We had a great time meeting so many women who are dedicated to getting fit while helping their community at the same time! If you are planning to run the Charlottesville Women’s 4 Miler next year or just want to get started with running, this training program is a great way to do it!

We gave training program participants a flyer with instructions on how to download our free book- A Runner’s Guide To Maintaining Healthy Feet & Ankles.  If you would like a copy, you can download it here: www.brfootandankle.com/book

Summer Blog Series: Shin Splints

July 19th, 2012 by Dr.Chang

Shin splints, also called tibial stress syndrome, are a common complaint of runners who increase their mileage or intensity too quickly. Feeling throbbing or aching in the shins is surprisingly common for athletes and runners. Shin splints, however, aren’t a single medical condition. They can be caused by a number of factors; irritated and swollen muscles, over use, stress fractures, over-pronation or flat feet, and running on hard surfaces, to name a few.  With shin splints you will feel a dull and aching pain in the front of the lower leg during exercise, or even after exercise. Shins may be painful to the touch, muscles can swell, and nerves can even be affected causing parts of the feet to go numb.

There are various places where the shin can cause pain. Usually, a flatfoot can cause pain in the tibialis posterior, or the front and outside of your shin. High arches can cause anterior lateral shin splints, on the inside of your shin. Less common is pain deep in the back of the leg, caused by tightness in your inner calf muscles, the soleal complex. No matter what kind, shin splints are a mechanical issue, caused by excessive mileage and a pounding stride.

There is good news for all of you who suffer from shin splints: they are very treatable, with quite high success rates! So have hope as you begin your treatment plan. Treatment for shin splints varies according to the nature of your own individual injury. In general, the very first thing to do is to rest in order for your injury to heal. Additionally, ice, NSAIDs, arch supports, range of motion exercises (as recommended by your podiatrist or physical therapist), a neoprene sleeve to support and warm the leg, and physical therapy will be recommended. If your shin splints are caused by stress fractures, you may be put in a walking boot or even need surgery for severe cases.

Remember that recovering from shin splints can be a frustratingly long process. Many runners need up to six months, or more, to recover. Resist the urge to start running again before you are ready, because your injury could become more severe. To bide time and to stay in shape until you heal, you can take up activities that have little impact on your legs such as swimming or cycling. You will know when you are ready to run again by a number of factors including equal flexibility in your legs, activity does not cause pain, or when x-rays show that your stress fractures have healed. To avoid shin splints wear good shoes with the right amount of support for your foot, warm up and then stretch before working out, run on soft surfaces, and stop working out when you feel pain in your shins.

 

 

 

Women athletes, especially those who run and do triathlons, are often told that they are more susceptible to certain lower extremity pain. But what are the unique qualities of the female physique and subsequent common injuries? This post will discuss lower extremity pain common among women due to musculo-skeletal characteristics, hormonal changes and even cultural factors. Below you will also find a few simple suggestions for reducing the risk of foot and ankle injuries. However, Ladies, injuries are cause by a variety of factors and treated in a variety of ways depending on your individual body type and list of activities. If you are experiencing foot and ankle pain, never hesitate to consult your local Charlottesville podiatrist for more information.

Female Musculo-Skeletal Factors in Injuries

There are a few factors that doctors consider when discussing female-specific injuries. Foremost, the angle that represents the relationship between the pelvis, leg and foot, referred to as the Q angle, is more dramatic in females because of women’s wider hips. Knowing this angle is important for athletes because repetitive and continual stress throughout the lower back, pelvis, hip, knee and ankle will often produce injuries in the lower part of the body, especially among women with wider Q angles. Determining whether your Q angle falls outside of the normal range may help in considering the causes of foot and ankle pain, not to mention pain in the lower back, pelvis and even the neck.  If you are concerned that your Q angle is affecting your running or causing foot and ankle pain, visit Dr. Murray and Dr. Chang for a professional assessment. They will be able to provide various suggestions, including fitting you with over the counter and custom orthotics.

Common running injuries due to a wide Q angle include patellofemoral pain syndrome or runner’s knee, iliotibial (IT) band syndrome, and shin splints. Women commonly feel pain from patellofemoral pain syndrome, otherwise known as runner’s knee, behind or around the kneecap. Runner’s knee has a range of causes – from over use, direct trauma or misalignment to flat feet. Women commonly are afflicted by runners knee due to a weak VMO muscle (vastus medialis oblique <<image>>), a muscle in the interior thigh. The good news is that it is easy to strengthen the VMO through knee extension and hip abduction exercises. Contact your Charlottesville or Waynesboro podiatrist to find the right exercise plan for you.

Iliotibial band syndrome is also a common injury found among female runners and triathletes. The IT band is made up of tissue that runs on the outside of the thigh, from the pelvis to just below the knee. While crucial to stability during activity, its continual abrasion against the top of the femur and the knee can make it inflamed, causing pain in the hip, thigh and/or knee. Often, using a foam roller can help runners prevent and heal sore IT bands. Stretching is a great preventative measure for IT band pain. Try standing straight up, and bending to the side as far down as is comfortable. Two sets of 15 repetitions on each side should work wonders. Hip flexor exercises can do the trick as well. Kneel on one knee and turn the torso until you feel a stretch on the IT band. Hold this for 5-10 seconds, and repeat 3 times on each side. Again, consult Dr. Murray and Dr. Chang or another licensed professional to design the appropriate workout for you.

Shin splints, known to doctors as medial tibial stress syndrome (MTSS), result from too much force on the shinbone and the connective tissue attaching muscles to it. If you run, chances are that you’ve had the ‘splints. Studies show that up to 15% of running injuries are shin splints, and the advertisements in the back of running magazines are certainly a good testament to that fact. Shin splints are common among runners who have flat feet or over-pronate. In other cases they are caused by tightness in other various muscles and tendons (another good incentive to warming up and stretch!) and by increasing mileage too quickly. Try your best not to increase mileage more than 10% per week; especially with the female disposition to have diminished bone density, female runners are up to 3.5 times more likely than men to contract stress fractures from shin splints.

By far, the single most important to preventing shin splints, along with all of the Q-angle injuries mentioned above, is wearing properly fitted shoes and being attentive to when your shoes are worn out. Your local shoe dealers, Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes, can all provide foot assessments and expert advice about properly fitting shoes.

Age and Hormone-Related Causes of Injuries

The female Q angle can take tolls on knees, ankles and feet of all ages. High school athletes have a high incidence of injuries to the ligaments in the knees, primarily the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), because they tend to lack the lateral stability and endurance necessary for optimal performance and injury prevention. Some experts write that 30% of all ACL tears occur among high school females due to the Q-Angle of the female hip. Some helpful tips for ACL/MCL injury prevention among teens include not neglecting a 5-10 minute warm up, followed by stretching, planning for rest, and staying hydrated. High school athletes can also benefit from light to moderate lateral plyometrics such as lunges and squats, and even light weight lifting.

Female-specific hormones may have great effect on female runners throughout their lives. Hormones, such as relaxin, that women release during pregnancy lead to the relaxation of ligaments. Biologically, this allows for smoother births, but these hormones can affect ligaments in the feet, leading to arch pain, collapsed arches, plantar fasciitis and over pronation. While the jury is still out on the benefits of running during pregnancy, most experts agree that easy running in moderation can be helpful for second trimester moms who are runners, as long as it is balanced with enough time resting the feet and attentiveness to overheating and hear rate levels. Consult your obstetrician to determine a proper exercise routine during your pregnancy.

Not surprisingly, pregnancy may necessitate larger shoe sizes due to swelling. Ligament laxity may permanently increase shoe sizes or altered foot shape. Cramming a new foot size into old shoes too often results in foot and ankle pain. Contact your local shoe experts to determine whether your shoe size has changed, and what the best new fit might be – your feet are worth it!

And what about running injuries during menopause? The experts are still out on whether running correlates to an easier ride through menopause. However, the precaution about menopause often is that diminishing bone density resulting from hormonal changes can often lead to osteoporosis. Boosting the amount of calcium in your diet to between 1000-1500 mg before menopause is a good preventative measure to ward off post-menopausal osteoporosis, especially for female runners. Keeping running and strength training up can keep your bones strong, help prevent bone fractures and healthy circulation, not to mention running’s other physical and emotional benefits!

Other Causes of Female Injuries

In addition to biology, nurture, or cultural influences, may be factors in female injuries as well. High heels often lead to bunions, hammertoe, ingrown toenails, sesamoid injuries, Morton’s Neuroma, back pain and other problems. Remember that good-looking shoes are not exclusive of comfort. Consider buying shoes with arch support and room in the toe box from stores like Richey and Co. Shoes.

But high heels are not the only culprits of foot and ankle pain! If your running or athletic shoes do not fit or are worn out, you can likely injure your legs, ankles or feet. Be attentive to the wear in your shoes, and buy new athletic shoes frequently – according to your podiatric experts, Dr. Murray and Dr. Chang, the appropriate shoes will prevent a host of injuries!

Unfortunately, female athletes are particularly susceptible to eating disorders, and what doctors have come to know as the “Female Athlete Triad.” The triad is made up of an eating disorder and weight loss, amenorrhea (missed periods), and osteoporosis. Poor nutrition can lead to bone loss, decreased serum estrogen levels, psychological abnormalities, and, in extreme cases, death. Those who suffer from the Female Athlete Triad may experience fatigue, anemia, depression, decreased concentration, constipation, cold intolerance, and parotid gland enlargement seen in the cheeks. If this isn’t bad enough, the boneless can cause stress fractures that will not heal without proper nutrition and self-care.

Nurture your body! Healthy eating leads to strong bones and can keep you strong, fit and running your best. Balanced and healthy diets improve athletic performance, prevent osteoporosis, and aid in the healing of injuries. Consuming a target of 1000 mg of calcium per day, with sufficient Vitamin D for calcium absorption (which can either be derived from sunlight or regulated supplements), will help prevent stress fractures. Visit our page on bone healing for more information.

So, to all the female runners out there, stay strong and inspired, and remember that consulting your doctor, fully understanding the various causes of injuries and taking care of yourself will aid in injury prevention and healing.

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

 

Helping Amy Find Amy Again

March 3rd, 2011 by Dr.Chang

This week we had the pleasure of meeting with Amy (you may know her as Suzy from SuzySaid) about some problems she is having with shin splints as she adds running to her current exercise routine.

For the past 9 months or so Amy has been focusing on finding herself again through exercise and a healthy lifestyle.  To keep herself motivated, she is documenting her journey on her blog, Finding Amy Again.

The things that she is experiencing are very similar to the plight of many of our patients.  They are well intentioned thirty and forty something’s who have lost their youthful athletic prowess and are now returning to the sports arena only to get injured in the process.  We have partnered with her to keep her feet and ankles healthy and we will document her progress on our blog in hopes that it will inspire other people who are in the same ‘shoes’ as Amy.

Our meeting began with a conversation about her exercise routines.  Amy trains at Clay Fitness and has more recently started added running to her routine.  She shared with us that she really wants to train for a local race (she has already done a 4 miler!) but her shins are making it very difficult to complete more than 2-3 miles without a lot of pain. She exercises in shoes fitted to her by local running shoes experts at the Ragged Mountain Running Shop.  Her running shoes are neutral positioning shoes and are not worn.

The pain that she experiences is inside and outside on her anterior shin bone (tibia) and comes with high intensity activity.  It shows up when doing her Clay Fitness circuit training after about 20-30 minutes or when running at about 3 miles or so.  The condition resolves slowly after stopping activity.  The recovery day that follows bring about substantial soreness in the same areas.

We did a quick evaluation of Amy’s foot structure and stance.  She has an upright rectus Cavus foot structure.   We must emphatically note that the cavus foot is a poor shock absorber and rather unforgiving foot. It does not accommodate the ground or uneven surfaces very well.  We immediately suspected this may be a root of the cause of her problem. You can find more information on cavus foot here .

Our conclusion: Amy has classic signs of shin splints (listed below).  This is a fairly common condition for an individual who is beginning a new exercise regimen and has an existing foot structure prone to it’s development.

So what are shin splints exactly?
The term shin splints is a name use often to describe any pain in the front and lower leg.  However, the “true” shin splint is reserved for pain, arising from a number of causes, at the front inside edge of the shin bone (tibia).  The most common cause is inflammation of the periosteum (sheath of tissue surrounding all bones) of the tibia.  This inflammation is a result of repetitive traction forces of the muscles of the lower legs that arise at these locations on the bones.  The tern Medial Tibial Periostitis is often used for shin splints.

Amy has some of the classic signs for shin splints:
1.    Pain over the lower half of the shin bone
2.    Pain at the beginning of exercise which settles as the session continues, but returns when fatigue levels are reached.
3.    Pain returning after activity and may worsen next day
4.    Swelling
5.    Focal “lumpy/bumpy” tissue on inside of the shin bone
6.    Pain on range of motion toe and feet in downwards position.
7.    Redness on inside of shin bone, usually present with swelling if occurs.

Causes of shin splints are centered around abnormal biomechanics (patterns of movement) and errors in training.  Some common causes are:
1.    Over pronating (flattening)  feet
2.    Over supinating (arching) feet
3.    Inadequate and unsupportive shoes
4.    Increasing training too soon
5.    Running on uneven surfaces
6.    Inappropriate warm-up/cool-down and stretching

Treatment Strategies
The most important element in long term management of shin splints is to control the abnormal mechanical issue.  The most immediate problem to address is the acute inflammation at the muscle bone interface.

Acute inflammation is resolved with R.I.C.E. principles (Rest ice compression and elevation.  ) and anti-inflammatory medication.

Biomechanical problems are addressed with taping, appropriate shoes, and well designed  shoe orthotics.

When shin splints are active.  Cease the causative exercises and start cross training to rest the injured area.

For Runners, avoid hard pavements and uneven surfaces.  Tarmac, grass and trail runs can reduce shock to the legs and feet.

As a rule of thumb with running, distances should not increase by more than 10% per week.  This help to prevent over use injuries.

Shin splints can be caused by tight posterior lower leg calf muscles (gastroc, soleus, and posterior tibialis).  Regular regimented stretching daily and deep muscle massage can improve flexibility

So what did we do for Amy?
1)    Prescribed over the counter inflammatory medication e.g. ibruprofen
2)    Performed analysis of foot in stance.  We will evaluate her gait next visit.
3)    Applied a plantar rest strapping (tape) to her feet and instructed on how to accomplish this on her own at home.  She should wear while exercising and when in next day recovery when she is sore.
4)    Advised patient to do deep tissue massage on the the posterior leg muscles, avoid inflamed areas of pain.  Do calf muscle stretching daily and pre/post exercise.

We will see how our initial treatment plan for Amy helps to resolve her symptoms over the next two weeks.   We expect the results to be good.  If plantar rest strapping (tape) helps, this is an excellent signal to us that orthotic therapy will help.  We will then proceed with manufacturing some custom orthotics for her.  The goals of orthotics therapy will be cavus foot shock absorption and subtalar joint stabilization and control.  Keep checking back to see how it’s going! We hope we can help Amy find Amy again.

Doc, why won’t my shin splints get better?

November 24th, 2010 by Dr.Chang

Compartment syndrome masked as shin pain, recalcitrant.I had a recent case that challenged my diagnostic skills. A young soccer athlete was referred to me who complained of right lower leg pain following the start of soccer practice approximately 6 weeks prior to presentation in my office. He had been initially diagnosed with “shin splints” and treated with R.I.C.E methods by his team trainer. His symptoms persisted and he was seen by his primary care doctor. The assessment was same. He was suffering from “severe” shin splints. Oral anti-inflammatory meds, R.I.C.E. and some home exercises were given. NO response then he was ordered outpatient physical therapy. A few treatments went by without relief; the patient’s primary care provider referred him to me.

My exam showed the patient demonstrated “classic” shin splint palpable tenderness along the distal medial and anterior lateral aspects of the right leg. The worsening of the pain with exercise was present, also a common finding in the shin splint injuries. With my athlete patients I will often make the patient exercise to the point of where they get similar onset of pains reported. We did so. He described pain that was both an ache and a burn in sensation at same locations above. He had strong pulses. All sensation was intact. This young man had very large, muscular calves which were very tight and turgid even in resting condition. His leg x-rays were negative for stress fracture. My next most likely diagnosis was Chronic Exertional Compartment Syndrome (CECS).  I set up a time to analyze leg compartmental pressures: resting and post exercise reading are indicated.  His were 10 mm and 38 mm respectively.

Shin splints have a variety of presentations.

This syndrome can encompass a number of overuse disorders, they all share a common finding of periostitis (bone inflammation) near the origins of the soleus and/or flexor digitorum longus muscles. Flexor origin shin splints tend to be distal medial in pain…. Soleus origin shin splints can be that but also deeper and lateral (seemingly – anterior pain in location) … This is the tricky presentation…. . Commonly, the patient demonstrates many contributing factors most notable being; structural pathology predisposes patients to excessive and unbalanced pronation during the run/gait cycle, with subsequent overuse of the muscles of the distal extremity.

The differential diagnosis for this condition includes: stress fracture, chronic or exertional compartment syndrome, sciatica, deep venous thrombosis, popliteal artery entrapment, muscle strain, tumor, and infection.

Digging deeper for some answers…

Exertional compartment syndrome is a condition in athletes that can occur from repetitive activities and progressive competitive training. The anterior compartment of the leg is the most commonly affected location. Patients describe pain also as is burning in nature, which worsens with activity and completely subsides after 15 minutes of activity cessation. It seems, initial activity places a demand for blood supply for the muscles. This results in vascular inflow, engorgement, and expansion of the muscles in a confined fascial structure or “compartment”. The result is relative compression and pain. Resting and immediate post exercise is the gold standard for the diagnosis of chronic exertional compartment syndrome. A dynamic, post-exercise reading of greater than of 35 mm Hg is highly indicative of compartment syndrome. A dynamic pressure greater than 40 mm Hg is considered diagnostic.

Conservative therapy may help in the near term, but the condition will often flare when athletics are resumed. When indicated, surgical decompression via fasciotomy of the involved compartment is definitive in correction of the problem.

What is to become of this young athlete?

Considering the failure of conservative care, and the indisputable pressures measured…. the patient elects undergo anterior leg compartment release. I expect this to fully solve his problem. For me, lessons are always learned.
On referral patients, which are a good bulk of our clinic’s sports medicine cases, I always seek a wide ranged differential diagnosis. It may walk like a duck, and talk like a duck, but some times geese can look and talk that way too. In this case, I applaud the referring provider who saw that this patient may benefit from a specialist’s point of view. I called her on my findings, diagnosis and course of care for the patient in question. I got the proverbial …. “Ah Hah..I knew it !” As it turns out here, the referring physician demonstrated more than adequate working knowledge of lower extremity. As doctors, we are not expected to know everything… but we need to be smart enough to know what we don’t know.

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