Chronic Lower Leg Pain in Athletes: Overview of Presentation and Management

Abstract

Background

Athletes with chronic lower leg pain present a diagnostic challenge for clinicians due to the differential diagnoses that must be considered.

Purpose/Questions

We aimed to review the literature for studies on the diagnosis and management of chronic lower leg pain in athletes.

Methods

A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The PubMed, Scopus, and Cochrane library databases were searched, and articles that examined chronic lower leg pain in athletes were considered for review. Two independent reviewers conducted the search utilizing pertinent Boolean operations.

Results

Following two independent database searches, 275 articles were considered for initial review. After the inclusion and exclusion criteria were applied, 88 were included in the final review. These studies show that the most common causes of lower leg pain in athletes include medial tibial stress syndrome, chronic exertional compartment syndrome, tibial stress fractures, nerve entrapments, lower leg tendinopathies, and popliteal artery entrapment syndrome. Less frequently encountered causes include saphenous nerve entrapment and tendinopathy of the popliteus. Conservative management is the mainstay of care for the majority of cases of chronic lower leg pain; however, surgical intervention may be necessary.

Conclusions

Multiple conditions may result in lower leg pain in athletes. A focused clinical history and physical examination supplemented with appropriate imaging studies can guide clinicians in diagnosis and management. We provide a table to aid in the differential diagnosis of chronic leg pain in the athlete.

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Neil Mohile, BS, Jose Perez, MD, Michael Rizzo, MD, Christopher P. Emerson, MS, Greg Foremny, MD, Paul Allegra, MD, Harry Greditzer IV, MD, and Jean Jose, DO, declare that they have no conflicts of interest.

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Mohile, N., Perez, J., Rizzo, M. et al. Chronic Lower Leg Pain in Athletes: Overview of Presentation and Management. HSS Jrnl 16, 86–100 (2020). https://doi.org/10.1007/s11420-019-09669-z

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Keywords

  • athlete
  • chronic pain
  • lower leg
  • tendinopathy
  • stress fracture
  • compartment syndrome
  • entrapment