Claudication of the Foot in a Rugby Player
A 26-year-old man presented with claudication in the left foot after 5 minutes of jogging. The only cardiovascular risk factor was smoking. Clinical examination was normal. Ankle brachial index (ABI) was 1.05 on the right and 0.99 on the left side. ABI did not change with exercise. Magnetic resonance angiography showed a bilateral agenesis of the posterior tibial artery and a blood supply of the feet mainly via a dominant fibular artery (Figure). The left fibular artery shows a stenosis at the level of the left foot. Refined history reveals repetitive trauma (or hammer syndrome) on the same spot during rugby training and games corresponding with the location of the stenosis.
The patient protected his foot better when playing rugby, stopped smoking, was started on a platelet inhibitor medication, and did not want to undergo percutaneous transluminal angioplasty. After 9 months, the patient is nearly symptom free, has a bilateral ABI of 1.06 and has restarted playing competitive rugby.