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Help with patient with lateral leg pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by yehuda, Mar 16, 2005.

  1. yehuda

    yehuda Active Member

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    I have a patient that has had pain on the lateral aspect of the leg for several months which starts approx 1/3 of the way up the leg and radiated downwards, the insertion points of the peroneal brevis and extensor digitorum brevis are painfull when pressed.

    At first I considered lateral shin splints BUT the pain occurs in bed when sitting when walking and is basically consistent, my understanding of shin splints is exercise induced.

    on ulltasound and ct nthing show up.

    the patient has xs stj pronation

    what do you guys/gals think (have to be politically correct) :confused: :confused:


  2. Yehuda, it would be more helpful if you were able to specifically identify the anatomical areas of tenderness. If the styloid process of the fifth metatarsal is tender and there is increased pain with eversion of the STJ against resistance, then think insertional tendinitis of the peroneus brevis. EDB insertion sites are the digits. Are the digits tender??

    Shin splints is not a diagnosis, but rather is a "garbage-can" full of unrelated diagnoses that all cause leg pain. Shin splints my include muscle strain, tendinitis, medial tibial stress syndrome, chronic exertional compartment syndrome, tibial or fibular stress fracture and other less common diagnoses. Using the term "shins-splints" is somewhat like a primary care physician saying that the patient has a diagnosis of "foot pain". Not very helpful at all!

    Peroneus brevis insertional tendinitis can hurt at rest if it is bad enough, but generally hurts more as the patient becomes more active.

    MRI scans are helpful to diagnosis peroneal tendinopathy and/or tears in peroneal tendons. Please provide more information for more help.
  3. GarethNZ

    GarethNZ Active Member

    Some questions...

    Which activity is it worse during? Sitting, Walking or lying in bed?

    Does it come on at the same time during walking?

    Is there any tenderness along the fibular? How long have her symptoms been effecting her?
  4. yehuda

    yehuda Active Member


    the pain on the foot is at the insertion point of the peroneus brevis and on the belly of the EDB (sorry i meant belly not insertion in my question)

    I have always understood "shin splints" to mean chronic exertional compartment syndrome thanks for the correction

    The patients main concern is the pain in the lower third of the leg THERE IS NO DIFFERENCE wether she is walking sitting or running ect. the pain startd approx 3 months ago.

    generally the pain is a throb that spreads downwards but occasionally she will have shooting pains.

    thanks for your help

  5. Craig Payne

    Craig Payne Moderator

    Slump test?
  6. yehuda

    yehuda Active Member

    :confused: :confused:
  7. Yehuda:


    1. Was there any history of trauma?
    2. Was there a change in shoe gear or activity?
    3. Did the pain begin suddenly or gradually over time?
    4. Is the pain worse at night and better during the day?
    5. Is there any pain to dorsiflexion of the lesser digits against resistance?
    6. Is there any pain to eversion of the STJ against resistance or to dorsiflexion of the ankle against resistance?
    7. Is there normal sharp/dull and light touch in the distribution of the common peroneal nerve and/or in the lateral distal leg and lateral foot? (The EDB is innnervated by the deep peroneal nerve and the peroneus brevis is innervated by superficial peroneal nerve.)
    8. Any history of lower back pathology? (The lateral distal leg is supplied by the L5, S1 and S2 nerve roots.)
    9. Is there any asymmetry in the walking or running gait examination?

    If it is a radiculopathy, then local anesthetic block of the sural, or common peroneal nerve will not likely relieve the patient's pain. However, a good neurological examination will likely tell you quite a bit about whether it is neurogenic or musculoskelatal in origin. Therefore, a nerve block wouldn't be my first choice for diagnosis.

    It is not a chronic exertional compartment syndrome since CECS hurts only during exercise and resolves soon after exercise is completed.

    Once you have decided as to whether it is neurogenic or musculoskeletal in origin, then treatment decisions will be much easier to make.
  8. Craig Payne

    Craig Payne Moderator

    Slump test? = standard test for any vague lateral foot/leg pain = test for adverse neural tension.
    Google search for .slump test/neural tension
  9. yehuda

    yehuda Active Member

  10. yehuda

    yehuda Active Member

    thanks for the advise i have checked most of these things but am going to rexamine in a few days will get back to you

    yehuda :)
  11. DTT

    DTT Well-Known Member


    Slump test :-

    Looked it up .

    Thanks again for making me THINK !!!!!! ;)


  12. Craig Payne

    Craig Payne Moderator

    We would probably routinely use the Slump Test (and some of its variations) on anyone who present with vague/non-specific foot and/or leg pain. If is positive (approx 10-30% in the patients we see are +ve), we do nothing more and pass them on...
  13. Atlas

    Atlas Well-Known Member

    Craig's spot on. Check the slump, but with the foot ankle in an inverted position to bias more of the CPnerve, rather than the tibial.

    Another thing is to exclude non-mechanical causes. I think you said that the pain was consistent? Do you mean constant? 24 hours per day throbbing? If so, that sounds quite non-mechanical, and simple radiology or referral might be the go.

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