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Musculoskeletal and Sports Medicine

Persistent Lower Extremity Pain in a Collegiate Diver: Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 3

    Poster Presenter(s)

  • Katelyn Lotz, DO

    Resident Physician
    University of Cincinnati Medical Center/College of Medicine PM&R Program
    Cincinnati, Ohio

    • Co-Author(s)

  • Victoria Heasley, MD

    Assistant Professor in PM&R and Sports Medicine
    University of Cincinnati

Disclosure(s):
Katelyn Lotz, DO: No financial relationships to disclose
Victoria Heasley, MD: No financial relationships to disclose
Case Diagnosis: 21 year old college diver with history of left ACL repair at age 14 presents with a year of left lower leg pain, found to have left common peroneal nerve compression, superficial peroneal nerve compression, tibial nerve compression, and exertional compartment syndrome after extensive workup.

Case Description or Program Description: Patient presented with a year of numbness, tingling, and sharp shooting pain along the medial tibia. Initial management at the previous clinic included presumed stress fracture diagnosis with boot immobilization for three months, compartment steroid injections, and intra-articular steroid knee injections, which provided minimal to temporary relief. Our examination revealed weakness in dorsiflexion/plantarflexion, and tenderness at the proximal fibula. EMG was normal. MRI of the lumbar spine was negative, MRI of the calf showed low-grade myotendinous strain of the peroneus longus muscle and incidental aberrant high takeoff of the anterior tibial artery. A MRA showed no signs of popliteal artery entrapment.
Despite treatment efforts, the patient experienced increased pain and swelling upon returning to diving. Continued management led to surgical intervention including decompression and neurolysis at the common peroneal nerve, superficial peroneal nerve, tibial nerve at the soleal sling, and compartment releases of the lateral, anterior, and posterior compartments. Intraoperative findings confirmed significant nerve compression and thickened fascia throughout the leg.

Setting: Sports Medicine Clinic

Assessment/Results: Postoperatively, the patient experienced significant improvement in her symptoms. By 7 months she had resumed full activity with signficiant functional recovery and only intermittent mild numbness and tingling that improved with pregabalin.

Discussion (relevance): This case illustrates the complexity of diagnosing persistent lower extremity pain, especially in the setting of normal diagnostic studies. Differential diagnosis may include chronic exertional compartment syndrome, nerve entrapment, muscular strain, or popliteal artery entrapment.

Conclusions: Nerve entrapment and compartment syndrome with persistent lower extremity pain must be considered early and cannot always be ruled out with normal diagnostic studies.