calf/lower legEXERTIONAL COMPARTMENT SYNDROME
DEFINITION:
- Also known as “chronic compartment syndrome”.
- The muscles of the lower leg are surrounded by a layer of tissue with limited flexibility known as fascia. The area surrounded by the fascia is known as a compartment. Increasing activity results in an increased flow of blood to the muscle leading to an increase in muscle size. This increased size results in increased pressure in the compartment which can subsequently lead to compromise of the neurovascular structures in the leg. Permanent damage can be the result. (See illustration).
MECHANISM OF INJURY / HOW IT OCCURS:
- Often seen in runners with the sequence of events noted above.
- Repetitive, strenuous muscle usage.
- Can see with sudden significant change in level of activity.
- Trauma, such as a fracture to a long bone, can lead to an acute compartment syndrome, an entity approached emergently.
SYMPTOMS:
- Pain with activity and relieved with rest, usually by 30 minutes.
- Swelling and tightness to the leg.
- May experience numbness/tingling (paresthesias) to the foot and lower leg.
DIAGNOSIS:
- Physical examination, during exercise, will reveal tightness to the lower leg.
- May note decrease in sensation to the foot.
- Pressure measurements will demonstrate a large difference between rest and exercise.
- At rest, usually no abnormal findings.
- Note that acute compartment syndrome from direct trauma is an emergency.
TREATMENT/REHABILITATION:
- Rest, ice, and activity modifications are fundamental in the treatment of exercise induced compartment syndrome.
- Do not wrap the extremity as this may result in increased pressure.
- In rare instances surgical release (fasciotomy) may be required.
- Running on soft surfaces and wearing appropriate foot wear is helpful. (See recommendations under foot wear for runners).