Lower leg pain in anteriolateral region below fibula head

[davehayr]

I am a recreational runner (typically run 30 to 40 miles per week) and have been having this recurring injury in the anteriolateral region of my lower right leg, below the fibula head. I first had the problem in December 2007. I don't recall any particular change in my training leading up to the injury. It started again gradually in January 2009 this time after I had begun adding some hill intervals and speed intervals to my training. On both occasions it left me unable to run for a couple of months. After a gradual return to running in April, I recently ran a marathon without any problems. But now after a weeks rest and with no running, I have noticed the beginnings of this same injury, although it has maybe taken a week for me to notice it because I was taking ibuprofen for a few days to combat the inevitable stiff legs after the marathon.

Basically I have this dull ache in an area within a couple of inches below the fibula head. The ache is quite diffuse and difficult to pinpoint. The region isn’t swollen or sore when pressed, nor is it sore to walk. I just have this near constant annoying dull ache whether I’m walking, sitting or in bed. Sometimes it is more noticeable than others and sometimes it radiates down my leg. I have been for a few short runs since the marathon and it isn’t painful while running either, but the day after a run the ache is a little more intense than the last time.

This is following the same progression as it did twice before. On previous occasions, despite cutting back on my mileage and intensity, the dull ache gradually deteriorated over a couple of weeks into a more distinct pain which could eventually be felt when running upon each foot strike. The pain was in the region of what I think must be the Peroneus Longus or Extensor Digitorum Longus muscles (could be wrong here, not totally sure what muscles are involved in that region). The area also became sore when pressed, although there was no visible swelling. When I had this injury in January, I tried to manage it by having days off between runs until the pain subsided and keeping my pace down, icing and taking ibuprofen after runs, but on my final run, had I not been caught in a heavy snow shower then I would have stopped and walked, but as I was so cold and wet I ran through the pain to get home. Big mistake! For weeks afterwards even just an attempt at a gentle jog/run when crossing the street gave an instant sharp pain upon foot strike, making running impossible. Walking wasn’t really a problem, nor stairs, nor standing on my tip toes, although oddly if I were to squat down with my knees at my feet, as I stood back-up and the angle between my shin and foot passed through a point around 30 degrees I got this very sharp pain in this same region.

Anyone recognise / experienced this injury? Very frustrating as it seems it will keep recurring, and with a broken hand I am unable to cross train at the moment. I’d be very grateful for any comments/advice. Thanks.

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[Lachlan]

My advice would be to see a physiotherapist.

Get them to assess the area and they will likely do some soft tissue massage through there and other treatments depending what they find.

It could be one of many things, the fact that it prevents you from running for months suggests that it is not of muscular origin (unless its compartment syndrome)

It is also possible to have fibular stress fractures, its really difficult to tell from your description. Trial 6 weeks of physio, if its not getting better go see a sports physician or get an MRI scan.

It could even be referred from the lumbar spine.