12: Exertional Leg Pain in Runners — Diagnosis, Gait, and Fueling

In this episode of Interdisciplinary Case Miles, Co-hosts Dr. Kate Mihevc Edwards (PT), Dr. Sara Raiser (MD) and Kelsey Pontius (RD) discuss a case about a exertional leg pain in a 19-year-old collegiate distance runner.

Dr. Sarah Raiser leads this case and explains how exertional leg pain can present in runners, outlining key diagnoses such as chronic exertional compartment syndrome (CECS) and popliteal artery entrapment syndrome (PAES). The discussion also covers how these conditions differ from stress fractures, nerve-related pain, and other causes of lower-leg symptoms, as well as how these cases are properly evaluated and diagnosed.Dr. Kate Mihevc Edwards addresses the physical therapy and gait-related factors that may contribute to exertional leg pain, including overstriding, crossover gait, heavy landings, strength deficits, and footwear considerations. She discusses when conservative management may be appropriate, when surgery may be indicated, and the importance of runner-specific, functional strength training during rehabilitation.Sports dietitian Kelsey Pontius shares the nutrition considerations relevant to these cases, including hydration, blood flow, anti-inflammatory nutrition, nitrates, and the role of adequate fueling to support recovery, gait changes, and long-term adaptation—particularly in injured collegiate and high-level runners.Key topics in this episode include:

• Common causes of exertional leg pain in runners
• Chronic exertional compartment syndrome vs. other diagnoses
• Gait retraining and physical therapy considerations
• Surgical and non-surgical treatment options
• The role of fueling and hydration in injury recovery

This episode is relevant for runners experiencing persistent lower-leg pain, clinicians working with endurance athletes, athletes, coaches and anyone interested in an interdisciplinary, evidence-informed approach to running injuries.

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