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Lower Leg Injuries

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Book cover Nuclear Medicine and Radiologic Imaging in Sports Injuries

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Abstract

Lower leg pain and injury is a common occurrence in athletes that has been described in the medical and athletic literature. The various pathoanatomic processes, which could present as lower leg pain in the athlete, include medial tibial stress syndrome (MTSS), chronic exertional compartment syndrome (CECS), stress fracture, tendinopathy, nerve entrapment syndromes, vascular syndromes, and muscle injuries. The etiopathogenesis and clinical presentations of these conditions are described, and a brief account of diagnostic studies and treatment options is discussed.

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Abbreviations

AMA:

American Medical Association

CECS:

Chronic exertional compartment syndrome

EMG:

Electromyography

ERLP:

Exercise-related leg pain

MRI:

Magnetic resonance imaging

MTSS:

Medial tibial stress syndrome

NIRS:

Near-infrared spectrometry

PAES:

Popliteal artery entrapment syndrome

PNI:

Peripheral neurogenic inflammation

SPECT:

Single-photon emission computed tomography

References

  • Amendola A, Rorabeck CH, Vellett D, Vezina W, Rutt B, Nott L (1990) The use of magnetic resonance imaging in exertional compartment syndromes. Am J Sports Med 18(1):29–34

    Article  CAS  PubMed  Google Scholar 

  • Anderson MW, Ugalde V, Batt M, Gacayan J (1997) Shin splints: MR appearance in a preliminary study. Radiology 204(1):177–180

    Article  CAS  PubMed  Google Scholar 

  • Andreisek G, White LM, Sussman MS, Langer DL, Patel C, Su JW, Haider MA, Stainsby JA (2009) T2*-weighted and arterial spin labeling MRI of calf muscles in healthy volunteers and patients with chronic exertional compartment syndrome: preliminary experience. AJR Am J Roentgenol 193(4):W327–W333

    Article  PubMed  Google Scholar 

  • Andrish JT, Bergfeld JA, Walheim J (1974) A prospective study on the management of shin splints. J Bone Joint Surg Am 56(8):1697–1700

    CAS  PubMed  Google Scholar 

  • Anil G, Tay KH, Howe TC, Tan BS (2011) Dynamic computed tomography angiography: role in the evaluation of popliteal artery entrapment syndrome. Cardiovasc Intervent Radiol 34(2):259–270

    Article  PubMed  Google Scholar 

  • Aoki Y, Yasuda K, Tohyama H, Ito H, Minami A (2004) Magnetic resonance imaging in stress fractures and shin splints. Clin Orthop Relat Res April (421):260–267

    Google Scholar 

  • Aweid O, Del Buono A, Malliaras P, Iqbal H, Morrissey D, Maffulli N, Padhiar N (2012) Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clin J Sport Med 22(4):356–370

    Article  PubMed  Google Scholar 

  • Banal F, Gandjbakhch F, Foltz V, Goldcher A, Etchepare F, Rozenberg S, Koeger AC, Bourgeois P, Fautrel B (2009) Sensitivity and specificity of ultrasonography in early diagnosis of metatarsal bone stress fractures: a pilot study of 37 patients. J Rheumatol 36(8):1715–1719

    Article  PubMed  Google Scholar 

  • Barry NN, McGuire JL (1996) Acute injuries and specific problems in adult athletes. Rheum Dis Clin North Am 22(3):531–549

    Article  CAS  PubMed  Google Scholar 

  • Batt ME, Ugalde V, Anderson MW, Shelton DK (1998) A prospective controlled study of diagnostic imaging for acute shin splints. Med Sci Sports Exerc 30(11):1564–1571

    Article  CAS  PubMed  Google Scholar 

  • Beck BR (1998) Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Med 26(4):265–279

    Article  CAS  PubMed  Google Scholar 

  • Beck BR, Osternig LR (1994) Medial tibial stress syndrome. The location of muscles in the leg in relation to symptoms. J Bone Joint Surg Am 76(7):1057–1061

    CAS  PubMed  Google Scholar 

  • Bennell KL, Brukner PD (1997) Epidemiology and site specificity of stress fractures. Clin Sports Med 16(2):179–196

    Article  CAS  PubMed  Google Scholar 

  • Bennell K, Matheson G, Meeuwisse W, Brukner P (1999) Risk factors for stress fractures. Sports Med 28(2):91–122

    Article  CAS  PubMed  Google Scholar 

  • Bennett JE, Reinking MF, Pluemer B, Pentel A, Seaton M, Killian C (2001) Factors contributing to the development of medial tibial stress syndrome in high school runners. J Orthop Sports Phys Ther 31(9):504–510

    Article  CAS  PubMed  Google Scholar 

  • Boden BP, Osbahr DC (2000) High-risk stress fractures: evaluation and treatment. J Am Acad Orthop Surg 8(6):344–353

    CAS  PubMed  Google Scholar 

  • Boden BP, Osbahr DC, Jimenez C (2001) Low-risk stress fractures. Am J Sports Med 29(1):100–111

    CAS  PubMed  Google Scholar 

  • Boody AR, Wongworawat MD (2005) Accuracy in the measurement of compartment pressures: a comparison of three commonly used devices. J Bone Joint Surg Am 87(11):2415–2422

    Article  PubMed  Google Scholar 

  • Bouche RT, Johnson CH (2007) Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction. J Am Podiatr Med Assoc 97(1):31–36

    Article  PubMed  Google Scholar 

  • Breit GA, Gross JH, Watenpaugh DE, Chance B, Hargens AR (1997) Near-infrared spectroscopy for monitoring of tissue oxygenation of exercising skeletal muscle in a chronic compartment syndrome model. J Bone Joint Surg Am 79(6):838–843

    CAS  PubMed  Google Scholar 

  • Brennan FH Jr, Kane SF (2003) Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome. Curr Sports Med Rep 2(5):247–250

    Article  PubMed  Google Scholar 

  • Bresler M, Mar W, Toman J (2012) Diagnostic imaging in the evaluation of leg pain in athletes. Clin Sports Med 31(2):217–245

    Article  PubMed  Google Scholar 

  • Brewer RB, Gregory AJ (2012) Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment. Sports Health 4(2):121–127

    Article  PubMed Central  PubMed  Google Scholar 

  • Brukner P, Bradshaw C, Khan KM, White S, Crossley K (1996) Stress fractures: a review of 180 cases. Clin J Sport Med 6(2):85–89

    Article  CAS  PubMed  Google Scholar 

  • Burne SG, Khan KM, Boudville PB, Mallet RJ, Newman PM, Steinman LJ, Thornton E (2004) Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study. Br J Sports Med 38(4):441–445

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Clanton TO, Solcher BW (1994) Chronic leg pain in the athlete. Clin Sports Med 13(4):743–759

    CAS  PubMed  Google Scholar 

  • Clement DB (1974) Tibial stress syndrome in athletes. J Sports Med 2(2):81–85

    Article  CAS  PubMed  Google Scholar 

  • Clement DB, Taunton JE, Smart GW, McNicol KL (1981) A survey of overuse running injuries. Phys Sportsmed 9:47–58

    Google Scholar 

  • Diebal AR, Gregory R, Alitz C, Gerber JP (2012) Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. Am J Sports Med 40(5):1060–1067

    Article  PubMed  Google Scholar 

  • Edmundsson D, Toolanen G, Thornell LE, Stal P (2010) Evidence for low muscle capillary supply as a pathogenic factor in chronic compartment syndrome. Scand J Med Sci Sports 20(6):805–813

    Article  CAS  PubMed  Google Scholar 

  • Edwards P, Myerson MS (1996) Exertional compartment syndrome of the leg: steps for expedient return to activity. Phys Sportsmed 24(4):31–46

    Article  CAS  PubMed  Google Scholar 

  • Edwards PH Jr, Wright ML, Hartman JF (2005) A practical approach for the differential diagnosis of chronic leg pain in the athlete. Am J Sports Med 33(8):1241–1249

    Article  PubMed  Google Scholar 

  • Elias DA, White LM, Rubenstein JD, Christakis M, Merchant N (2003) Clinical evaluation and MR imaging features of popliteal artery entrapment and cystic adventitial disease. AJR Am J Roentgenol 180(3):627–632

    Article  CAS  PubMed  Google Scholar 

  • Fayad LM, Kawamoto S, Kamel IR, Bluemke DA, Eng J, Frassica FJ, Fishman EK (2005) Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? AJR Am J Roentgenol 185(4):915–924

    Article  PubMed  Google Scholar 

  • Franklyn M, Oakes B, Field B, Wells P, Morgan D (2008) Section modulus is the optimum geometric predictor for stress fractures and medial tibial stress syndrome in both male and female athletes. Am J Sports Med 36(6):1179–1189

    Article  PubMed  Google Scholar 

  • Fredericson M, Bergman AG, Hoffman KL, Dillingham MS (1995) Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 23(4):472–481

    Article  CAS  PubMed  Google Scholar 

  • Fronek J, Mubarak SJ, Hargens AR, Lee YF, Gershuni DH, Garfin SR, Akeson WH (1987) Management of chronic exertional anterior compartment syndrome of the lower extremity. Clin Orthop Relat Res July (220):217–227

    Google Scholar 

  • Gaeta M, Minutoli F, Scribano E, Ascenti G, Vinci S, Bruschetta D, Magaudda L, Blandino A (2005) CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 235(2):553–561

    Article  PubMed  Google Scholar 

  • Gaeta M, Minutoli F, Vinci S, Salamone I, D’Andrea L, Bitto L, Magaudda L, Blandino A (2006) High-resolution CT grading of tibial stress reactions in distance runners. AJR Am J Roentgenol 187(3):789–793

    Article  PubMed  Google Scholar 

  • Garth WP Jr, Miller ST (1989) Evaluation of claw toe deformity, weakness of the foot intrinsics, and posteromedial shin pain. Am J Sports Med 17(6):821–827

    Article  PubMed  Google Scholar 

  • George CA, Hutchinson MR (2012) Chronic exertional compartment syndrome. Clin Sports Med 31(2):307–319

    Article  PubMed  Google Scholar 

  • Gershuni DH, Yaru NC, Hargens AR, Lieber RL, O’Hara RC, Akeson WH (1984) Ankle and knee position as a factor modifying intracompartmental pressure in the human leg. J Bone Joint Surg Am 66(9):1415–1420

    CAS  PubMed  Google Scholar 

  • Glorioso J, Wilkens J (2001) Exertional leg pain. In: O’Connnor F, Wilder R (eds) Textbook of running medicine. McGraw-Hill, New York, pp 181–198

    Google Scholar 

  • Groves AM, Cheow HK, Balan KK, Housden BA, Bearcroft PW, Dixon AK (2005) 16-Detector multislice CT in the detection of stress fractures: a comparison with skeletal scintigraphy. Clin Radiol 60(10):1100–1105

    Article  CAS  PubMed  Google Scholar 

  • Holder LE, Michael RH (1984) The specific scintigraphic pattern of “shin splints in the lower leg”: concise communication. J Nucl Med 25(8):865–869

    CAS  PubMed  Google Scholar 

  • Howard JL, Mohtadi NG, Wiley JP (2000) Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin J Sport Med 10(3):176–184

    Article  CAS  PubMed  Google Scholar 

  • Hubbard TJ, Carpenter EM, Cordova ML (2009) Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc 41(3):490–496

    Article  PubMed  Google Scholar 

  • Hutchinson MR, Ireland ML (1994) Common compartment syndromes in athletes. Treatment and rehabilitation. Sports Med 17(3):200–208

    Article  CAS  PubMed  Google Scholar 

  • James SL, Bates BT, Osternig LR (1978) Injuries to runners. Am J Sports Med 6(2):40–50

    Article  CAS  PubMed  Google Scholar 

  • Johnell O, Rausing A, Wendeberg B, Westlin N (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res July (167):180–184

    Google Scholar 

  • Jones DC, James SL (1987) Overuse injuries of the lower extremity: shin splints, iliotibial band friction syndrome, and exertional compartment syndromes. Clin Sports Med 6(2):273–290

    CAS  PubMed  Google Scholar 

  • Kirby RL, McDermott AG (1983) Anterior tibial compartment pressures during running with rearfoot and forefoot landing styles. Arch Phys Med Rehabil 64(7):296–299

    CAS  PubMed  Google Scholar 

  • Kortebein PM, Kaufman KR, Basford JR, Stuart MJ (2000) Medial tibial stress syndrome. Med Sci Sports Exerc 32(3 Suppl):S27–S33

    CAS  PubMed  Google Scholar 

  • Lambert AW, Wilkins DC (1999) Popliteal artery entrapment syndrome. Br J Surg 86(11):1365–1370

    Article  CAS  PubMed  Google Scholar 

  • Lassus J, Tulikoura I, Konttinen YT, Salo J, Santavirta S (2002) Bone stress injuries of the lower extremity: a review. Acta Orthop Scand 73(3):359–368

    Article  PubMed  Google Scholar 

  • Lesho EP (1997) Can tuning forks replace bone scans for identification of tibial stress fractures? Mil Med 162(12):802–803

    CAS  PubMed  Google Scholar 

  • Leversedge FJ, Casey PJ, Seiler JG 3rd, Xerogeanes JW (2002) Endoscopically assisted fasciotomy: description of technique and in vitro assessment of lower-leg compartment decompression. Am J Sports Med 30(2):272–278

    PubMed  Google Scholar 

  • Lohrer H, Nauck T (2007) Endoscopically assisted release for exertional compartment syndromes of the lower leg. Arch Orthop Trauma Surg 127(9):827–834

    Article  PubMed  Google Scholar 

  • Loudon JK, Dolphino MR (2010) Use of foot orthoses and calf stretching for individuals with medial tibial stress syndrome. Foot Ankle Spec 3(1):15–20

    Article  PubMed  Google Scholar 

  • Love JW, Whelan TJ (1965) Popliteal artery entrapment syndrome. Am J Surg 109:620–624

    Article  CAS  PubMed  Google Scholar 

  • Lundvall J, Mellander S, Westling H, White T (1972) Fluid transfer between blood and tissues during exercise. Acta Physiol Scand 85(2):258–269

    Article  CAS  PubMed  Google Scholar 

  • Magnusson HI, Westlin NE, Nyqvist F, Gardsell P, Seeman E, Karlsson MK (2001) Abnormally decreased regional bone density in athletes with medial tibial stress syndrome. Am J Sports Med 29(6):712–715

    CAS  PubMed  Google Scholar 

  • Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG (1987) Stress fractures in athletes. A study of 320 cases. Am J Sports Med 15(1):46–58

    Article  CAS  PubMed  Google Scholar 

  • Mattila KT, Komu ME, Dahlstrom S, Koskinen SK, Heikkila J (1999) Medial tibial pain: a dynamic contrast-enhanced MRI study. Magn Reson Imaging 17(7):947–954

    Article  CAS  PubMed  Google Scholar 

  • Mavor GE (1956) The anterior tibial syndrome. J Bone Joint Surg Br 38-B(2):513–517

    CAS  PubMed  Google Scholar 

  • McCrory P (2000) Exercise-related leg pain: neurological perspective. Med Sci Sports Exerc 32(3 Suppl):S11–S14

    CAS  PubMed  Google Scholar 

  • McDermott AG, Marble AE, Yabsley RH, Phillips MB (1982) Monitoring dynamic anterior compartment pressures during exercise. A new technique using the STIC catheter. Am J Sports Med 10(2):83–89

    Article  CAS  PubMed  Google Scholar 

  • McDonald AT, Seidenberg PH, Noll D, Watson JT, Kieffer DA, O’Connor FG (2006) Bilateral forearm pain in an equestrian rider. MSSE 38(5):S161

    Google Scholar 

  • Meier TO, Schneider E, Amann-Vesti B (2010) Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization. Vasa 39(2):189–195

    Article  CAS  PubMed  Google Scholar 

  • Messier SP, Pittala KA (1988) Etiologic factors associated with selected running injuries. Med Sci Sports Exerc 20(5):501–505

    Article  CAS  PubMed  Google Scholar 

  • Meyer SA, Saltzman CL, Albright JP (1993) Stress fractures of the foot and leg. Clin Sports Med 12(2):395–413

    CAS  PubMed  Google Scholar 

  • Michael RH, Holder LE (1985) The soleus syndrome. A cause of medial tibial stress (shin splints). Am J Sports Med 13(2):87–94

    Article  CAS  PubMed  Google Scholar 

  • Micheli LJ, Solomon R, Solomon J, Plasschaert VF, Mitchell R (1999) Surgical treatment for chronic lower-leg compartment syndrome in young female athletes. Am J Sports Med 27(2):197–201

    CAS  PubMed  Google Scholar 

  • Milgrom C, Giladi M, Simkin A, Rand N, Kedem R, Kashtan H, Stein M, Gomori M (1989) The area moment of inertia of the tibia: a risk factor for stress fractures. J Biomech 22(11–12):1243–1248

    Article  CAS  PubMed  Google Scholar 

  • Moen MH, Bongers T, Bakker EW, Weir A, Zimmermann WO, van der Werve M, Backx FJ (2010) The additional value of a pneumatic leg brace in the treatment of recruits with medial tibial stress syndrome; a randomized study. J R Army Med Corps 156(4):236–240

    Article  CAS  PubMed  Google Scholar 

  • Moen MH, Bongers T, Bakker EW, Zimmermann WO, Weir A, Tol JL, Backx FJ (2012a) Risk factors and prognostic indicators for medial tibial stress syndrome. Scand J Med Sci Sports 22(1):34–39

    Article  CAS  PubMed  Google Scholar 

  • Moen MH, Rayer S, Schipper M, Schmikli S, Weir A, Tol JL, Backx FJ (2012b) Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study. Br J Sports Med 46(4):253–257

    Article  CAS  PubMed  Google Scholar 

  • Mohler LR, Styf JR, Pedowitz RA, Hargens AR, Gershuni DH (1997) Intramuscular deoxygenation during exercise in patients who have chronic anterior compartment syndrome of the leg. J Bone Joint Surg Am 79(6):844–849

    CAS  PubMed  Google Scholar 

  • Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M (2008) Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am 90(11):2322–2330

    Article  PubMed  Google Scholar 

  • Mubarak SJ, Hargens AR, Owen CA, Garetto LP, Akeson WH (1976) The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool. J Bone Joint Surg Am 58(7):1016–1020

    CAS  PubMed  Google Scholar 

  • Mubarak SJ, Gould RN, Lee YF, Schmidt DA, Hargens AR (1982) The medial tibial stress syndrome. A cause of shin splints. Am J Sports Med 10(4):201–205

    Article  CAS  PubMed  Google Scholar 

  • Nissen LR, Astvad K, Madsen L (1994) Low-energy laser therapy in medial tibial stress syndrome. Ugeskr Laeger 156(49):7329–7331

    CAS  PubMed  Google Scholar 

  • Ohta-Fukushima M, Mutoh Y, Takasugi S, Iwata H, Ishii S (2002) Characteristics of stress fractures in young athletes under 20 years. J Sports Med Phys Fitness 42(2):198–206

    CAS  PubMed  Google Scholar 

  • Orava S, Karpakka J, Hulkko A, Vaananen K, Takala T, Kallinen M, Alen M (1991) Diagnosis and treatment of stress fractures located at the mid-tibial shaft in athletes. Int J Sports Med 12(4):419–422

    Article  CAS  PubMed  Google Scholar 

  • Ota Y, Senda M, Hashizume H, Inoue H (1999) Chronic compartment syndrome of the lower leg: a new diagnostic method using near-infrared spectroscopy and a new technique of endoscopic fasciotomy. Arthroscopy 15(4):439–443

    Article  CAS  PubMed  Google Scholar 

  • Paik RS, Pepples D, Hutchinson MR (2013) Chronic exertional compartment syndrome. BMJ 346:f33

    Article  PubMed  Google Scholar 

  • Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH (1990) Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 18(1):35–40

    Article  CAS  PubMed  Google Scholar 

  • Pham TT, Kapur R, Harwood MI (2007) Exertional leg pain: teasing out arterial entrapments. Curr Sports Med Rep 6(6):371–375

    PubMed  Google Scholar 

  • Plisky MS, Rauh MJ, Heiderscheit B, Underwood FB, Tank RT (2007) Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. J Orthop Sports Phys Ther 37(2):40–47

    Article  PubMed  Google Scholar 

  • Puranen J (1974) The medial tibial syndrome: exercise ischaemia in the medial fascial compartment of the leg. J Bone Joint Surg Br 56-B(4):712–715

    CAS  PubMed  Google Scholar 

  • Reinking MF (2006) Exercise-related leg pain in female collegiate athletes: the influence of intrinsic and extrinsic factors. Am J Sports Med 34(9):1500–1507

    Article  PubMed  Google Scholar 

  • Rich NM, Collins GJ Jr, McDonald PT, Kozloff L, Clagett GP, Collins JT (1979) Popliteal vascular entrapment. Its increasing interest. Arch Surg 114(12):1377–1384

    Article  CAS  PubMed  Google Scholar 

  • Roberts A, Franklyn-Miller A (2012) The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review. Scand J Med Sci Sports 22:585–595

    Article  CAS  PubMed  Google Scholar 

  • Rome K, Handoll HH, Ashford R (2005) Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev (2):CD000450

    Google Scholar 

  • Rompe JD, Cacchio A, Furia JP, Maffulli N (2010) Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome. Am J Sports Med 38(1):125–132

    Article  PubMed  Google Scholar 

  • Rorabeck CH, Castle GS, Hardie R, Logan J (1981) Compartmental pressure measurements: an experimental investigation using the slit catheter. J Trauma 21(6):446–449

    CAS  PubMed  Google Scholar 

  • Rupani HD, Holder LE, Espinola DA, Engin SI (1985) Three-phase radionuclide bone imaging in sports medicine. Radiology 156(1):187–196

    Article  CAS  PubMed  Google Scholar 

  • Saxena A, O’Brien T, Bunce D (1990) Anatomic dissection of the tibialis posterior muscle and its correlation to medial tibial stress syndrome. J Foot Surg 29(2):105–108

    CAS  PubMed  Google Scholar 

  • Shaffer SW, Uhl TL (2006) Preventing and treating lower extremity stress reactions and fractures in adults. J Athl Train 41(4):466–469

    PubMed Central  PubMed  Google Scholar 

  • Slimmon D, Bennell K, Brukner P, Crossley K, Bell SN (2002) Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg. Am J Sports Med 30(4):581–588

    PubMed  Google Scholar 

  • Slocum DB (1967) The shin splint syndrome. Medical aspects and differential diagnosis. Am J Surg 114(6):875–881

    Article  CAS  PubMed  Google Scholar 

  • Sommer HM, Vallentyne SW (1995) Effect of foot posture on the incidence of medial tibial stress syndrome. Med Sci Sports Exerc 27(6):800–804

    Article  CAS  PubMed  Google Scholar 

  • Stager A, Clement D (1999) Popliteal artery entrapment syndrome. Sports Med 28(1):61–70

    Article  CAS  PubMed  Google Scholar 

  • Stickley CD, Hetzler RK, Kimura IF, Lozanoff S (2009) Crural fascia and muscle origins related to medial tibial stress syndrome symptom location. Med Sci Sports Exerc 41(11):1991–1996

    Article  PubMed  Google Scholar 

  • Styf J (1988) Diagnosis of exercise-induced pain in the anterior aspect of the lower leg. Am J Sports Med 16(2):165–169

    Article  CAS  PubMed  Google Scholar 

  • Styf JR, Körner LM (1986) Microcapillary infusion technique for measurement of intramuscular pressure during exercise. Clin Orthop Relat Res June (207):253–262

    Google Scholar 

  • Swenson EJ Jr, DeHaven KE, Sebastianelli WJ, Hanks G, Kalenak A, Lynch JM (1997) The effect of a pneumatic leg brace on return to play in athletes with tibial stress fractures. Am J Sports Med 25(3):322–328

    Article  PubMed  Google Scholar 

  • Touliopolous S, Hershman EB (1999) Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg. Sports Med 27(3):193–204

    Article  CAS  PubMed  Google Scholar 

  • Turnipseed WD (2009) Functional popliteal artery entrapment syndrome: a poorly understood and often missed diagnosis that is frequently mistreated. J Vasc Surg 49(5):1189–1195

    Article  PubMed  Google Scholar 

  • van den Brand JG, Verleisdonk EJ, van der Werken C (2004) Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome. Am J Sports Med 32(2):452–456

    Article  PubMed  Google Scholar 

  • van Zoest WJ, Hoogeveen AR, Scheltinga MR, Sala HA, van Mourik JB, Brink PR (2008) Chronic deep posterior compartment syndrome of the leg in athletes: postoperative results of fasciotomy. Int J Sports Med 29(5):419–423

    Article  PubMed  Google Scholar 

  • Veith RJ, Matsen FA, Newell SG (1980) Recurrent anterior compartmental syndromes. Phys Sportsmed 8(11):80–88

    Google Scholar 

  • Verleisdonk EJ (2002) The exertional compartment syndrome: a review of the literature. Ortop Traumatol Rehabil 4(5):626–631

    CAS  PubMed  Google Scholar 

  • Verleisdonk EJ, van Gils A, van der Werken C (2001) The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg. Skeletal Radiol 30(6):321–325

    Article  CAS  PubMed  Google Scholar 

  • Viitasalo JT, Kvist M (1983) Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sports Med 11(3):125–130

    Article  CAS  PubMed  Google Scholar 

  • Wallensten R (1983) Results of fasciotomy in patients with medial tibial syndrome or chronic anterior-compartment syndrome. J Bone Joint Surg Am 65(9):1252–1255

    CAS  PubMed  Google Scholar 

  • Wheeler P, Batt ME (2005) Do non-steroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med 39(2):65–69

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Whitesides TE, Heckman MM (1996) Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg 4(4):209–218

    PubMed  Google Scholar 

  • Whitesides TE, Haney TC, Morimoto K, Harada H (1975) Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res Nov-Dec (113):43–51

    Google Scholar 

  • Wittstein J, Moorman CT 3rd, Levin LS (2010) Endoscopic compartment release for chronic exertional compartment syndrome: surgical technique and results. Am J Sports Med 38(8):1661–1666

    Article  PubMed  Google Scholar 

  • Yates B, White S (2004) The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med 32(3):772–780

    Article  PubMed  Google Scholar 

  • Zhang Q, Lindberg LG, Kadefors R, Styf J (2001) A non-invasive measure of changes in blood flow in the human anterior tibial muscle. Eur J Appl Physiol 84(5):448–452

    Article  CAS  PubMed  Google Scholar 

  • Zhang Q, Jonasson C, Styf J (2011) Simultaneous intramuscular pressure and surface electromyography measurement in diagnosing the chronic compartment syndrome. Scand J Med Sci Sports 21:190–195

    Article  CAS  PubMed  Google Scholar 

  • Zhang Q, Rennerfelt K, Styf J (2012) The magnitude of intramuscular deoxygenation during exercise is an unreliable measure to diagnose the cause of leg pain. Scand J Med Sci Sports 22:690–694

    Article  CAS  PubMed  Google Scholar 

  • Zimmermann WO (2012) Developments in the treatment of chronic exertional compartment syndrome. Nederl Mil Geneesk T Sep (65):160–162

    Google Scholar 

  • Zimmermann WO (2013a) Sports compression stockings: the effect on the running performance of 100 soldiers with an overuse injury of the lower legs. Nederl Mil Geneesk T Jan 66:11–17

    Google Scholar 

  • Zimmermann WO (2013b) Chronic overuse injuries of the legs in military personnel: new findings in the soft tissues? Nederl Mil Geneesk T July 66:92–98

    Google Scholar 

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  1. Department of Sports Medicine, Royal Dutch Army, Utrecht, The Netherlands

    Wes O. Zimmermann MD

  2. Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

    Wes O. Zimmermann MD

  3. Sports Medicine, Department of Orthopaedics and Rehabilitation, Penn State Hershey Bone and Joint Institute – State College, Penn State University, University Park, PA, USA

    Peter H. Seidenberg MD, FAAFP, FACSM

  4. Private Practice Orthopaedist, Coffeyville Regional Medical Center, Coffeyville, KS, USA

    Yogesh V. Kolwadkar MD, MRCS, MCh, MS

Authors
  1. Wes O. Zimmermann MD
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  2. Peter H. Seidenberg MD, FAAFP, FACSM
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  3. Yogesh V. Kolwadkar MD, MRCS, MCh, MS
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Corresponding author

Correspondence to Wes O. Zimmermann MD .

Editor information

Editors and Affiliations

  1. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Andor W.J.M. Glaudemans

  2. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  3. Department of Radiology, Antwerp University Hospital, Edegem, Belgium

    Jan L.M.A. Gielen

  4. Exercise and Health, Center for Sports Medicine, University Center for Sport, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Johannes (Hans) Zwerver

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© 2015 Springer-Verlag Berlin Heidelberg

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Zimmermann, W.O., Seidenberg, P.H., Kolwadkar, Y.V. (2015). Lower Leg Injuries. In: Glaudemans, A., Dierckx, R., Gielen, J., Zwerver, J. (eds) Nuclear Medicine and Radiologic Imaging in Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46491-5_31

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  • DOI: https://doi.org/10.1007/978-3-662-46491-5_31

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46490-8

  • Online ISBN: 978-3-662-46491-5

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