Re: Clinical Question

[Guest guest]

,

This patient has enough symptoms in which a Sports medicine or

orthopedic consult would be indicated. I would not suspect that

strength and endurance is this issue...maybe if it were bilateral and

you were just starting with this patient, not yet addressed

orthotics, shoes, running surface, training program and progression.

I recently attended a Sportsmedicine CEU course by the Cleveland

Clinic where one of the presenters had video presentation of the

compartment syndrome workup procedure which was very interesting.

As far as Hippa goes...I suggest starting your questions with " I uh

know this person, not me of course who presents with... "

Anyway...suggest a consult.

Gephart, PT, CSCS

> I am writing regarding a 37-something year old patient whom I

initially

> treated for plantar fasciitis. All symptoms have responded to

treatment,

> range of motion is close to normal and symmetrical, and he has

completed a

> course of strengthening and balance exercises. He has a goal of

returning

> to running -- an activity he has not participated in for several

years.

> Over the past few months, he has been successful in slowly

increasing his

> running time on a treadmill. At different points, he has been able

to run

> 40 minutes at over 5 mph. However, he has recurrent episodes of

his right

> lateral (peroneal area) leg " locking up, " as he describes it, during

> running. He keeps a journal of his activities, and initially we

attributed

> these episodes to change of running surface, dehydration (symptoms

would

> occur after long flights) and these types of things.

>

> Unfortunately, these episodes have begun to occur more frequently

and

> outside of any pattern we can identify. He has orthoses in his

shoes, and

> he has changed running shoes in case that was contributing. He

lacks good

> control of pronation on the right and is unstable at push-off, with

tendency

> to avoid completing push-off at the great toe. We have worked on

this, and

> his current strengthening program emphasizes heel raises with focus

on

> stability of the foot and ankle, post tib and FHL strengthening.

Other

> lower quarter findings are normal except for: excessive internal

rotation

> right hip and mild weakness right external rotation; left

iliotibial band

> tightness. He also has a tendency to over-recruit toe extensors

for ankle

> dorsiflexion, so we are working on isolated ant tib strengthening.

>

> He is at his wit's end, and I am a little stumped, too. He sent me

an

> article, questioning whether he had exertional compartment

syndrome. Does

> anyone have experience with this diagnosis or any other ideas?

Apparently,

> diagnosis of chronic compartment syndrome can be difficult because

signs

> resolve quickly with stopping activity.

>

> In case anyone is concerned, I mostly follow this patient by

telephone, and

> he pays out of pocket for intermittent follow-up visits. Please

advise me

> if you think I have violated HIPAA in anyway -- I believe I have

properly

> de-identified his case.

>

> I welcome your thoughts.

>

> Pennisi

> Chicago, IL 60614

> LakeshoreSportsPT.com