Refractory Lateral Leg Pain in a 25-Year-Old Competitive Runner: A Report of a Case of Fascial Herniation of the Peroneus Brevis With Complete Resolution After Surgical Decompression

Fascial herniations of the leg occur when an intracompartmental leg muscle protrudes through weaknesses in the overlying fascial sheath. These fascial defects may be congenital or acquired from trauma involving penetrating injuries to the fascia. Increases in intracompartmental pressure, often resulting from muscular hypertrophy, can lead to muscular herniation through the weakened fascia. This may present as a leg mass which is often misdiagnosed as a hematoma, varicosity, or soft-tissue mass, leading to significant delays in treatment. We present a case of a peroneus brevis herniation in a 25-year-old male competitive runner with a history of a tibial stress fracture. This patient was referred to the senior author following three years of lateral leg pain worsened by activity. After confirmation of the herniation on MRI, the patient underwent a limited lateral compartment fasciotomy with complete resolution of symptoms at a six-month follow-up. This case demonstrates common pitfalls in the diagnosis of fascial herniations in refractory leg pain of runners. A comprehensive knowledge of this diagnosis and its risk factors can aid in the successful treatment of this patient cohort.