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The Active Supination Dorsiflexion Test Guided Therapeutic Intervention for Shin and Calf Pain: A Case Report

A 66-year-old male experienced right sided shin and calf pain of an insidious onset. The duration of pain was 3 months, aggravated by walking and running. He also reported resting pain especially during the night. A detail medical evaluation ruled out the presence of a blood clot and electrolyte imbalance. He was diagnosed as having restless leg syndrome and referred for physical rehabilitation. Initial examination revealed positive findings of comparable local tenderness over the right shin and calf. He also presented with foot pronation that persisted throughout the stance phase of gait. Hence his ability to reverse pronation was tested in the standing position. With the knees completely extended, he presented with an inability to actively supinate and dorsiflex the foot on the right side. 8 treatment visits for a period of 4 weeks addressed mechanical dysfunction at the ankle, foot, and hip region, comprising, manual therapy, corrective exercise and pain modalities. Reduction of local tenderness, and activity related shin and calf pain was observed. He reported continued discomfort at rest, but of a minimal intensity. Additionally, full range of active supination and dorsiflexion was restored in the standing position with the knees completely extended. The findings in this case report describe a common cause of shin pain. It highlights a novel and easily administered method of evaluating limited mobility in the talocrural joint and the relative inability to supinate the foot that could potentially contribute to the symptomatology. The test was of value in assessing the need as well as the outcome of rehabilitation intervention. Further research to examine the diagnostic utility of this method is recommended.