pain in inside of calf muscle

[elinekk]

Hello,

Dr Damian, you oviously know what you talk about. It has never crossed my mind to check for circular malfiunction.
Could you describe how I would have to take the pulse in legs and are you able to give me information (yourself or via article or website) on what would be considered normal and abnormal flow?
Thanks for that insight, I will not forget it!

Kind Regards,

Eline.

[Dr Damien]

There are many ways to check circulation,simple clinical ways or more complex radiographic reports.
The simplest is to feel with your two fingers for pulse just like you check the radial pulse looking for consistency or regularity and most importantly weakness in flow. weakness, felt thinly(described by academicians as thready pulsations) or not at all may suggest a compromise more proximally.you should not press down on the artery as that can give you a false negative result.having said that, the aterial system is marvellous in arteriogenesis(creating anastomosis) therefore if one feels normal (pulse feels adequate)does not mean all is well.

you could improvise with a doppler ultrasound machine to hear the flow.strong flow will be loud and sound like a dog barking(sometimes you can hear a little high frequency dog bark). The most important thing is to hear it and trust me when you do compared to a compromised circulatory situation you will know the difference.Place the doppler against the flow of the artery, trial and error may be needed sometimes to hear the flow.

other ways are to measure ankle/brachial ratios and I forget what the normal ranges are right now. This is perhaps the most objective you could get in a clinical situation. its just measuring the ratio of pedal pulses compared to brachial artery pulse.

finally, good old radio graphs are handy in showing you were a compromise is but you need a marker of a sort to be injected in the artery to outine the course of the circulatory system. Excessive opacities in any aterial segment compared to the contralateral part suggests a compromise.

Cyclists and rowers often get compromises without knowing because they bend a lot closing down the iliac arteries.they only notice when they start to run.

My reasoning is this: bilateral symptoms happening at the same time must have a more central or proximal cause. unlike unilateral problems that could be either. I am not saying you cant have bilateral problems that have independent unilateral causes, you could but if I was to see a case like that, what I would hold priority is a hypothesis that links both symptoms; I think that way because the body is a chain of little blocks.

I reckon that ruling out circulatory problems should be priority in sports medicine especially in unremitting cases. if it was standard practice to do that, I think it would be a lot better.

bilateral shin splints happening at the same time everytime in the same situation must have a link.It is harder to reason that one out, if that is the case, I would be happy to know why.

your suggestions are very valid because you considered many factors that could link both calf symptoms together e.g training shoes etc

I hope I was of some assistance

[physio.smith]

Definitely check out pulses and mobility of nerves, agree that generally if bilateral problem it may well be central in origin.

Pain on the inside of the calf can often be caused by medial periostitis, irritation where the facia attaches to the shin bones.

Generally where the symptoms are bilateral I have found that one leg is significantly worse than the other if it is not circulatory or neurologically related.

Definitely try and get to the bottom of your symptoms as I have seen a lot of cases of stress fractures in this area, where patients have ignored symptoms. Bone scanning has confirmed the diagnosis, however I don't feel that this is generally necessary, as it does not tend to change the treatment.

Biomechanics may be a large factor...
overpronation, tight calf complex, poor popliteus control (lack of locking / unlocking mechanism at knee may be affected), glut. med. control is often poor

Overtraining is often a big factor, you may need to vary the type of training you are doing, reduce the amount of impact activities etc... You can work on endurance and fitness with various low / lower impact work

Recover is important, allowing time for muscle damage (following a session) to recover, having the correct nutrition to optimise healing etc..

If it is musculoskeletal in origin then rest, appropriate strengthening and stretching, improvement of biomechanical issues and a graded return to activity (without aggrevating symptoms) is what is required.

Good luck.

[linbin]

hi guys
as suggested he should check circulatory,neural and stress fracture signs and relevant diagnostic tests.he did not gave a description of pain-superficial/deep,dull/localised/
irritability,
severity
stability
i feel he should also check for muscular involvement.tibialis posterior involvement can producen pain at similat site

[block]

I know its been mentioned - but circulatory tests are good but should also be done after exercise e.g. popliteal artery entrapment - resting post tib pulse is present but dissapears after the exercise which may be after 15 mins running or just a few caf raises - pop artery entrapment often comes with medical calf pain descrptions initally

Hope that helps

[linbin]

hi guys
i think we should also think about soleus syndrome/medial shin splint
should check for soleus muscle tightness

other examinations suggested
muscle strength of tibialis posterior
posture of foot-pronation
gait assessment
calcaneocuboid and talonavicular mobility assessment