This study states that Exertional leg pain occurring without peripheral arterial disease (PAD) is universally understood by our specialty and chronic exertional compartment syndrome (CECS) and popliteal artery entrapment syndrome are often diagnoses considered. In these patients, we are consultants to “rule out” PAD and usually it is a young, athletic individual and, even in older patients, their history, physical examination, and noninvasive studies are not consistent with PAD. In young patients, we often refer them for CECS testing, but in older patients most of us would not consider this diagnosis. This article is unique in raising awareness that CECS is present in older patients (>50 years of age) and their symptoms have subtle differences from patients with PAD. 1 The authors of this study are at an institution that is a national referral center for exercise-induced lower extremity pain and are exposed to CECS more often than surgeons in our country. It is interesting that even in this setting diagnostic delay was six times longer in the patient with CECS vs patients with PAD. This article offers insight into a group of patients that would likely be misdiagnosed or not diagnosed with a potentially treatable cause for their discomfort.

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