Members do not see these Ads. Sign Up.

Dear All,

Have just seen a 14 year old boy with some unusal running issues and I was wondering if others have seen something the same.

CC - long runs usually over 12 KM he starts getting a pain sensation in the lower 1/3 of the achilles in both feet approx 15cm superior to the inserion of the achilles as he continues he starts to get a sensation similar to pins and needles into the feet (plantar aspect) and then altered sensations like his foot is swollen and jelly like and twice the size yet there is no visual changes. If he stops running and stretches then feels better and then can run again but it comes back. He is active with Triathalons, xcountry running, fencing and school activity. He has no problems in any other activity it is only there after longer runs and has been present for years.

Nil Hlth issues
Mild tightness but does stretch regularly.
Has had some insertional achilles issues previously but this has been resolved with simple custom innersoles.
Nil back Hx, reflexes fine, vascular system fine.
Walking Gait - genu varum BF, compensatory pronation in BF for varum position abducted R reduced HC in BF.
Run Gait - marked neck flexion position.
The interesting thing is there is a Family Hx - his mother suffered from the same symptoms as a child but now can get it with walking, gym and general exercise.

I am thinking of an entrapment of the nerve within the achilles any other ideas?

I have put 4mm HR in all shoes and advised religious stretching daily for the next 2 - 3 weeks and to do the longer runs to see if there is a change in his symptoms. I am also thinking deep tissue work of the calf region and possible acupunture.

would be interested in others thoughts.

Regards

 

Popliteal Artery Entrapment Syndrome?

 

Mark:

This sounds like chronic exertional compartment syndrome (CECS) of the deep posterior compartment. Here is an article I wrote on CECS about 8 years ago.

 

Thanks Peter, why would you think artery supply? I would have thought the symptoms for arterial restriction would be different.

Thanks Kevin.

 

had a case a few years back with similar symptoms. I asked an esteemed colleague who proposed PAES. Subsequent US scans were negative, but I thought it should be ruled out with your pt.

Hope you get your Dx

 

Mark,
could investigate post ex arterial supply if you had a doppler US (or you could borrow mine). Book him in for appointment send for a run and review after symtoms appear (just thinking you should run with him, for saftey, and see if you keep up)
Regards Matt