Management of Chronic Exertional Compartment Syndrome and Fascial Hernias in the Anterior Lower Leg With the Forefoot Rise Test and Limited Fasciotomy

Abstract

Level IV, retrospective case series.

Ultrasound‐Guided Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg

“…Chronic exertional compartment syndrome is characterized by exertional pain, which usually affects the myofascial compartments of the leg 1 , 2 . Davis et al 3 recently defined a characteristic profile for these patients: young individuals, 24 years of age on average, with women (60%) being affected more often than men.…”

“…Chronic exertional compartment syndrome is thought to be caused by increased tissue pressure within the fascial compartment, but the exact pathophysiologic mechanism is not well understood. Transient ischemia related to impaired blood flow in the affected compartment has been implicated 1 , 3 . This process produces swelling, which is thought to increase intracompartmental pressure 5 .…”

“…This process produces swelling, which is thought to increase intracompartmental pressure 5 . Chronic exertional compartment syndrome affects the anterior or lateral compartment, with anterior compartment involvement being most common 1 , 3 . Focal muscle herniations through a defect in the fascial compartment wall, which may or may not be symptomatic, have been noted in anywhere from 15% to 50% of patients undergoing surgery for chronic exertional compartment syndrome despite normal preoperative examination findings for these herniations 6 .…”

MRI of Musculotendinous Injuries—Part I: “Non-strain” Injuries

“…Hernias are associated particularly with the superficial peroneal nerve (most commonly the medial dorsal cutaneous branch), where it exits the fascia at the anterolateral aspect of the lower third of the leg [25].…”

“…The fascia is intact on a proton density axial image (b) just distal to the muscle hernia. This small hernia was treated with surgical repair of the fascial defect Prognosis After fasciotomy for a muscle hernia, approximately 80 % of patients are satisfied [24,25]. Patient dissatisfaction can be due to numerous factors (occasionally prompting an MRI exam): persistent pain, weakness, dysesthesias, adhesions, swelling (due to venous congestion in the absence of competent fascia), and increased cosmetic deformity [26].…”