Diagnosis, Treatment Options, and Rehabilitation of Chronic Lower Leg Exertional Compartment Syndrome

Abstract

Chronic exertional compartment syndrome of the lower leg is a well-described and documented cause of exercise-related pain in recreational, elite, and military athletes. Although this condition is common, the exact underlying mechanisms, those most at risk, long-term effects on muscular strength if unrecognized, and prevention strategies are relatively uncertain. Runners are most commonly affected and can be markedly impaired by the recurrent, often predictable pain that develops with exercise. An accurate history, high index of suspicion, and compartment pressure testing before and after symptomatic exercise confirms the diagnosis. Conservative therapy is minimally effective. Fasciotomy is the treatment of choice for athletes who are unwilling to modify their exercise or sport.

Chronic compartment syndrome also affects nonathletic subjects: A prospective study of 63 cases with exercise-induced lower leg pain

“…This may be due to diagnostic problems, since definitive criteria for the diagnosis are not yet fully established; also, the pain may be caused by for us undiagnosed other coexisting pathological conditions. Our patients were older than those in previous studies (Blackman 2000, Brennan andKane 2003). This is a matter of sampling, but we did not actively recruit older subjects; we only informed our referents about CECS of the lower leg and told them to send all patients whom they suspected of having the syndrome.…”

Chronic exertional compartment syndrome of the leg

“…CECS should be suspected in any athlete who presents with chronic anterior leg pain which worsens with prolonged use and resolves upon cessation of activity. 95% of cases of CECS occur in the anterior and lateral compartments of the leg [5,8,14,32]. In select groups of athletes, other potential locations of CECS include the superficial and deep posterior compartments of the lower leg, as well as, the compartments of the thigh and forearm [4,12].…”

“…Risk factors for development of CECS include anabolic steroid and creatine use, which increases muscle volume [5]. Eccentric exercise also increases the risk due to decreased fascial compliance [5].…”

“…Eccentric exercise also increases the risk due to decreased fascial compliance [5]. Aberrant biomechanics in a runner such as a rear foot landing or overpronation can increase the risk of compartment syndrome secondary to differential weight loading and pressure on individual muscle groups in the lower leg [2].…”

“…1). The tibialis posterior muscle is contained within its own fascia, and is therefore referred to as the fifth compartment of the leg [2][3][4][5]26].…”