Calf pain in runners may be caused by venous insufficiency

Sportsman complaints in the legs are most often associated with diseases and/or trauma of the musculoskeletal system. More rarely disturbances of the vascular system, e.g., popliteal artery entrapment have been reported in sportsman. Venous entrapment or venous claudication is mainly observed in cases of deep venous thrombosis. We report a case of venous claudication in the right leg of a sportsman (long distance runner) without any history of venous thrombosis who presented himself to the Praxisklinik Sauerlach. After running one to two km the man had to stop running due to increasing numbness in the lower leg, aching muscles in the calf and finally pain. An orthopaedic evaluation including magnetic resonance imaging of the leg by two orthopaedic specialists did not reveal any disturbance in the musculoskeletal system being responsible for the pain. - At the first clinical evaluation in ambulatory surgery clinic in Sauerlach there were no visible signs of varicose veins in the legs. B-mode and duplex-sonographic investigation of the right leg revealed an enlarged (0.63 cm) insufficient sapheno-popliteal junction with reflux in the right leg, the investigation of the venous system in the left leg was normal. A popliteal artery entrapment was excluded by colour duplex sonography. The operative procedure, ligation of the sapheno-popliteal junction with segemental saphenous vein stripping, has been well tolerated. 2-3 weeks after ligation of the sapheno-popliteal junction and segmental saphenous vein stripping the patient resumed his running program and could run without any painful disturbances.

Athletes, e.g., runners with complaints in the leg should be investigated for musculoskeletal defect but also for vascular disease,e.g., small saphenous vein insufficiency. The choice of treatment is ligation of the sapheno-popliteal junction with segmental saphenous vein resection which gives the patient optimal results and allows practicing long-distance running shortly after the operation.