Exercise induced neuropathic lower leg pain due to a tibial bone exostosis.

Abstract

<b>Objectives</b>: The differential diagnosis of chronic exercise induced lower leg pain in sporters includes compartment syndrome and medial tibial stress syndrome. However, severe discomfort may also be caused by nerve entrapment.<b>Methods</b>: Here we present a marathon runner who reports pain day and night in the lower leg. Deep palpation suggested the presence of a bony tumor deep in the calf musculature, and digital pressure on the soleal sling was painful and elicited paresthesias in the foot. A swab test indicated a hypo-esthetic sole of the foot. Imaging revealed the presence of a tibial exostosis that was hypothesized to narrow the soleal tunnel and irritate the tibial nerve.<b>Results</b>: Via a medial infragenual approach, the soleal tunnel was opened. A bony prominence was found in direct contact to the tibial nerve. Resection of the exostosis with tibial nerve neurolysis completely abolished all of his symptoms.<b>Conclusion</b>: An awkward lower leg discomfort that is present at night and worsens during exercise combined with altered foot sole skin sensation in the presence of a tibial bone exostosis may suggest tibial nerve neuropathy. If conservative therapies fail, resection and neurolysis is advised.