Leg pain disorders

Exertional leg pain can be a difficult spectrum of disorders to diagnose and treat. Medial tibial stress syndrome, tibial stress reaction, and tibial stress fractures are overuse disorders that can cause substantial time away from competition. The keys to preventing stress fracture include adequate dietary consumption of calcium and vitamin D, and other targeted interventions in at-risk populations. Nonsurgical management usually allows patients to return to their earlier activity level, although prolonged rest often is needed. Surgical intervention can be considered for a patient with a recalcitrant stress fracture or a high-risk fracture of the anterior tibia or an athlete who needs to return to sports quickly. Current diagnostic criteria for chronic exertional compartment syndrome can lead to high rates of false-positive results. Criteria using improved standardized exercise testing may have greater sensitivity and specificity. Surgical release is successful for pain relief in chronic exertional compartment syndrome but may not lead to a return to full sports activity or active military duty. Early recognition and treatment of popliteal artery syndrome is critical to a good outcome.