Bi-Lateral Anterior Compartment Pain

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Bi-Lateral Compartment Pain

Hi, I have recently seen a 57 year old male, who is overweight, complaining of pain in the region of the Anterior Compartment of both lower limbs. The information provided and results of examination were:

 The problem has been present for over two years, the patient does not run but does play a lot of golf.
 The pain is brought on after walking for over an hour, it is worse when walking downhill or on a hard surface. Walking on grass does not cause as much discomfort but the pain is still present.
 The patient describes the pain as a diffused aching (indicated quite clealry the area of the Anterior Compartment). I was unable to replicate the discomfort either by direct palpation or when putting the lower limb and muscles through their ROM/testing strength.
 Upon examination, there were no obvious muscle weakness or abnormalities of the lower limbs that could be the cause of the problem – fully appreciate I may have missed something obvious.
 The patient has tried to treat with rest and NSAID but the discomfort always comes back.

I have ruled out Anterior Compartment Syndrome and also a stress fracture – the description of the pain and other symptoms does not fully support this. After doing a bit more research the symptoms seem to be pointing more towards atrophy of the Tibialis Anterior/periostitis of the Tibia.

For the next two weeks I have advised the patient to treat according to PRICE and will review in three weeks. I am considering looking at temporary insoles to offload the Anterior Tibialis to see if this helps and have referred to the GP for scan to check for atrophy of the Tibialis Anterior/periostitis and also stress fracture (although unlikely).

I would be grateful if anyone could provide some advice, I am concerned I am missing the obvious, or my approach to the treatment plan may not be the best way forward. Look forward to hearing from you all.

Rgds

S Dennison

 

Welcome "S" , great notes above! Well done!

I notice that you have 3 posts.

Hope you have found answers in other forums!

Cheers