113 - Leg Pain and Exertional Compartment Syndromes

Abstract

Exertional leg pain (ELP) is a common problem encountered in recreational and competitive athletes, representing a diagnostic challenge for even experienced providers. One of the significant causes of ELP is chronic exertional compartment syndrome (CECS). Particularly common in runners, this condition can affect any of the four compartments of the lower leg (i.e., anterior, lateral, superficial posterior, and/or posterior compartments) as exertion increases the intracompartmental pressure beyond what the compartment can accommodate. A clinical hallmark of CECS, the associated pain that surfaces with activity classically resolves as the exertion is decreased or stopped. In these patients the physical examination at rest and subsequent radiologic evaluation (e.g., plain films or MRI) should be unremarkable. While a clinical diagnosis, CECS is best confirmed by measuring intracompartmental pressures either pre- (>15 mm Hg), 1-minute post- (30 mm Hg), or 5-minutes post-exertion (20 mm Hg). Nonoperative treatment options include activity modification, altering one’s footwear (including the use of orthotics), adjusting the training regimen, physical therapy (e.g., stretching and strengthening), gait modification (e.g., forefoot running), and/or Botox injections. For patients who subsequently fail to return to their desired activity with these measures a surgical fasciotomy should be entertained. Single- or double-incision techniques are both widely used, and only the affected compartments should be released. Overall, there is a high rate of satisfactory outcome and return to sporting activities with a relatively low complication rate with the surgical treatment of CECS. Following surgery, the typical postoperative return to full activity occurs within 6 to 12 weeks.