Parietal abdominal pain with lower leg discrepancy: a case report

TL;DR

A man with chronic abdominal pain since childhood was found to have a leg length discrepancy causing muscle issues, which was successfully treated with physical therapy and injections.

Contribution

This is the first reported case linking parietal abdominal pain to lower limb length discrepancy.

Findings

Chronic abdominal pain was traced to a 3.8 cm left lower limb length discrepancy.

Treatment with a heel raise, botulinum toxin, and physiotherapy improved the patient's condition.

The case highlights the importance of thorough clinical examination in diagnosing non-obvious pain sources.

Abstract

This report involves the first publication describing a case of parietal abdominal pain due to lower limb length discrepancy.

A Caucasian male patient in his 50s was referred to our rehabilitation department with chronic abdominal pain that began in childhood. This chronic pain was associated with episodes of acute pain that were partially relieved by grade 3 analgesics. The patient was unable to sit for long periods, had recently lost his job, and was unable to participate in recreational activities with his children. Investigations revealed contracture and hypertrophy of the external oblique muscle and an limb length discrepancy of 3.8 cm (1.5 inches) in the left lower limb. The patient was effectively treated with a heel raise, physiotherapy, intramuscular injection of botulinum toxin, and lidocaine. The patient achieved the therapeutic goals of returning to work, and reducing analgesic use.

Structural misbalances, as may be caused by lower leg discrepancy, may trigger muscular compensations and pain. Complete anamnesis and clinical examination must not be trivialized and may reveal previously ignored information leading to a proper diagnosis.

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