Two years after Cathryn Roeck underwent surgeries to relieve leg pain, they were still experiencing pain so severe "it felt like [their] legs were going to burst," with no explanation for the painful symptoms. Then, doctors found the source of the pain — a commonly misdiagnosed vascular condition, Sandra Boodman writes for the  Washington Post.

'I thought it was really bad shin splints'

When Roeck, who is now 27 years old, was in high school, they developed leg pain while running on the cross-country team. Initially, the pain that radiated from their shins to the back of their calves was intermittent, but it became so severe during their junior year that finishing the cross-country season was no longer possible.

"I thought it was really bad shin splints [the result of inflammation of the muscles, tendons and tissue that covers the shin bones] or maybe a stress fracture," Roeck recalled. "I would be hobbling around after about a mile and a half."

When Roeck was running, their legs swelled and turned a bluish or purplish hue, and their left foot sometimes dragged. However, the pain quickly subsided with rest and the color returned to normal, so Roeck tried to ignore their symptoms.

Then, when Roeck was training for a triathlon during their senior year of college in 2018, it became obvious that running triggered their symptoms.

Roeck reached out to a physician assistant who sent them to a primary care doctor who specializes in sports medicine.

The primary care doctor told Roeck their problem was most likely one of three things — shin splints, a stress fracture, or a less common condition called chronic exertional compartment syndrome.

After ruling out shin splints and a stress fracture, their doctors conducted compartment pressure testing, which confirmed a borderline compartment syndrome diagnosis.

Roeck's orthopedic surgeon said, "If you're having symptoms we can do surgery." Without the surgery, running would continue to be painful for Roeck.

Two weeks later, the doctor performed surgery on all four compartments of Roeck's left leg. Three months later, the doctor performed the same surgery on their right leg.

In November 2019, Roeck underwent a third procedure to clear scar tissue from an old soccer injury on their right ankle.

Six weeks later, following a hiatus of almost a year, Roeck went on a short, pain-free run, leading them to believe the problem had been solved.

'It felt like my legs were going to burst'

However, "relief was relatively short-lived," Boodman writes. In the summer of 2021, after Roeck started training for a 5K run, their calf pain returned, and they started experiencing leg pain while standing at work.

"I thought it was probably shin splits," Roeck said.

In October 2021, Roeck's pain became more severe than anything they had ever experienced. "I've never felt pain like this," Roeck recalled. "It felt like my legs were going to burst."

After connecting with a new primary care doctor, Roeck was referred to a sports medicine specialist.

The specialist reviewed Roeck's records at a December 2021 appointment and ordered another round of compartment pressure testing, as well as assessments of the arteries in their lower legs and ankles.

Roeck's test results seemed to point to an uncommon condition called functional popliteal artery entrapment syndrome (PAES). Since Roeck's initial compartment pressure results were borderline, the specialist told them they should not have been a candidate for fasciotomy surgery. Then, the sports medicine doctor referred Roeck to a vascular surgeon for further evaluation.

"I had a lot of mixed emotions," Roeck said. "I had an answer as to why I wasn't fixed in the first place, but it meant I had to start all over again."

According to Boodman, "[c]hronic compartment syndrome and PAES cause similar and sometimes overlapping symptoms that can be difficult to disentangle. But there are important differences: PAES is a vascular problem — it affects the veins and arteries — and requires a different surgery than compartment syndrome."

"Misdiagnosis is not uncommon," Boodman writes. Roeck's vascular surgeon said she often sees patients like Roeck who have undergone the wrong surgery — typically a fasciotomy for compartment syndrome —because they did not go through a multidisciplinary work-up.

'This has been a real journey'

In April 2022, Roeck underwent surgery on their right leg, followed by the same surgery a month later on their left leg.

"Recovery was tougher than Roeck expected and required eight months of physical therapy," Boodman writes. "Roeck has resumed running about two miles at a time, which they alternate with walking and biking."

"I wish I hadn't ignored the pain for so long and pushed through it until I got to a breaking point," Roeck said. Ultimately, this experience taught Roeck to ask questions and assess medical information with a more critical eye.

"This has been a real journey," Roeck said. "I'm glad I'm on the other side of it." (Boodman, Washington Post, 4/1)