Posterior Tibial Arterial System Deficiency Mimicking Chronic Exertional Compartment Syndrome

Case: A 15-year-old female competitive high school basketball player presented as an outpatient with a 3-month history of bilateral exertional calf pain. Patient history and compartment pressure measurements were consistent with the diagnosis of chronic exertional compartment syndrome, and the patient underwent bilateral fasciotomies. Postoperatively, her symptoms recurred and she was found to have a deficient posterior tibial arterial system bilaterally, as confirmed on advanced imaging. Conclusion: We advocate the careful consideration of vascular etiologies in athletes who present with exertional leg pain.