A Rare Case of Intermittent Calf Pain: Gastrocnemius Fatty Degeneration
Department of Orthopedic Surgery, Egerton University, Kenya
Correspondence to: Dr. Kalande Fredrick. Email: firstname.lastname@example.org
Received: 11 Oct 2020; Revised: 08 Dec 2021; Accepted: 14 Dec 2021; Available online: 5th Feb 2022
Intermittent calf pain is also called claudication. It is common in patients with spinal canal stenosis or those with peripheral vascular occlusion disorders. It is rarely found in local muscle pathology. We herein report a case of a 50-year-old man who presented with left-sided calf pain on mild exertion. On evaluation, the systemic review was normal, with no spondylosis or vascular pathology, but with local fatty degeneration in the gastrocnemius, which was causing the calf pain. He was given analgesics and underwent physiotherapy and counseling, and his condition improved over 6 months.
Keywords: Claudication, Intermittent calf pain, Gastrocnemius, Fatty degeneration
Ann Afr Surg. 2022; 19(3): 158-160
© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Intermittent calf pain, also referred to as claudication, is common in patients who have vascular atherosclerosis. This leads to varied degrees of ischemia to the muscles of the leg, which presents as pain in the calf on exertion. It could also be due to spinal canal stenosis, which has a similar presentation, but it has additional spondylotic symptoms of numbness and or burning sensation in the affected body region (1).
Claudication affects 21–24% of the population who are younger than 60 years and 30–35% of those who are older than 70 years (2). Women are more affected than men in developing countries such as ours, i.e., Kenya. Claudication is commonly seen in smokers and diabetics with predilection for the hip, thigh, and calf (in order of frequency) (3). Local causes of claudication are very rare, and fatty degeneration is a rarer cause of claudication as an entity in the absence of the above two conditions, and it is a diagnosis by exclusion (4), especially in female patients.
Osteoarthritis of the adjacent joints leads to poor physical performance and strength in the associated group of muscles. It is known to occur in the thigh and calf as a sequalae of hip and knee joint arthritis. Disuse atrophy and fat infiltration occur in these muscles and impact on their functionality (5). Gastrocnemius degeneration is known to cause knee pain in rare occasions (5).
There are other myopathies in literature such as nemaline myopathy (6) and Miyoshi myopathy (7), which present as calf pain and reduced regional functional performance, especially in the Asian population, in which these rare congenital muscle anomalies are more common.
Although rare, its significant local muscle pathology broadens the scope of differential diagnosis for claudication beyond the commonly known systemic pathologies and when managing a patient’s local pathology such as fat degeneration and myopathies.
A 50-year-old personnel officer, who was previously an athlete and does not smoke or drink alcoholic, presented with complaints of pain of the left calf for 6 months. The pain was insidious, and it was worsened by activity such as walking or running, which he does as a hobby and to maintain fitness, but he is no longer a high-performing athlete. After about 500 m of walking or 20 minutes of brisk walking, calf pain occurs, and he was unable to walk until he rests for 10 minutes or more, after which he can resume the activity. He had no history of low back pain, numbness of the legs, trauma to the leg, or chronic illness such as diabetes mellitus or hypertension. He had used both topical and oral nerve modulators without improvement.
On examination, we found a healthy, 82-kg man, with body mass index of 28, good general condition, and without anemia or lower limb edema. All the observations were normal. The left calf muscle was tender on the medial side. The calf was soft and non-shiny, with a circumference of 38 cm measured at 6 cm from the tibial tuberosity. On peripheral vascularity assessment, the popliteal artery and dorsalis pedis artery pulses were of normal volume character and rhythm. The ankle brachial index was 1. The muscle power grade was 5/5 in all the compartments of the leg. The ankle reflexes were all normal. Right leg circumference was 35 cm measured at 6 cm from the tibia