Chronic Compartment Syndrome Symptoms and Treatment

Runner on the beach holding his lower leg in pain
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Chronic compartment syndrome is an unusual sports injury that generally occurs in runners or other athletes who do any sort of repetitive motion exercise along with excessive weight-bearing or excessive force on the lower legs. Chronic compartment syndrome is also called exertional compartment syndrome because it is typically caused by overuse or excessive use of the muscles. The most common location for athletes to experience part compartment syndrome is in the muscles of the lower leg.

Symptoms of Compartment Syndrome

The main symptoms of compartment syndrome are caused by compression of the soft tissues in and around the affected muscle group. Symptoms of nerve and tissue compression such as numbness, tingling, pain, weakness, and burning are most commonly felt along the front of the lower leg.

Other symptoms include foot drop in the affected leg. Foot drop basically means just that, with the compression of the muscles and nerves that travel to the foot, there is an associated loss of control and coordination of the muscles that lift the foot up, and the foot drops downward. Foot drop, along with bulging tissue like small hernias on the front of the shins coupled with the other symptoms, indicates an extreme compartment syndrome. 

The other major sign of compartment syndrome is generalized pain that begins when you start exercising and continues to get worse the longer you exercise, and then tends to slowly dissipate after you stop exercising. For newer cases, the pain stops within an hour or so of halting exercise, but if the compression is severe or chronic, a dull pain can linger for a day after the workout.

Causes and Diagnosis

In the arms and legs, a tough tissue called fascia surrounds the different muscle groups. This fascia is basically a small compartment that surrounds the muscles, blood vessels and nerves. Fascia has limited flexibility, so if the muscle swells beyond the fascia's ability to stretch it puts pressure on the nerves and blood vessels in the small space. If swelling continues, blood flow to the muscles will decrease, nerves get compressed and it can cause numbness or tingling in the feet and lower legs.

The most accurate way to diagnose this condition is to insert a needle into the compartment immediately after the activity that causes pain and measure the pressure. Pressure reading that measures greater than 45 mmHg indicates compartment syndrome.

Compartment syndrome occurs more often in runners, although any athlete can be affected. Because of the location of the pain, it is often initially misdiagnosed as shin splints or a stress fracture.

Treatment for Chronic Compartment Syndrome

The first course of treatment for chronic compartment syndrome is to rest the affected muscles to reduce the swelling and inflammation. Other conservative treatments include icing, stretching, and elevating the lower leg after activity. Switching exercises for a while is also recommended to reduce the impact on the lower body. If, for example, you have been running, it's helpful to try a non-impact sport instead.

In many cases, compartment syndrome is treated with surgery to release the fascia and allow more room in the compartment. The surgery is fairly straightforward but isn't risk-free. It's important to talk with your doctor to understand the risks and benefits of this type of surgical procedure.

To avoid compartment syndrome, it's helpful to wear the right footwear, run on soft surfaces and mix up your training volume. Paying attention to any aches and pains by reducing your running time and intensity may also limit the chance of developing compartment syndrome.

As with all sports-related injuries, a visit to a physician for a proper diagnosis and treatment plan is essential.

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Article Sources
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  • American Academy of Podiatric Sports Medicine, Chronic Compartment Syndrome.

  • Blackman, Paul. A review of chronic exertional compartment syndrome in the lower leg. Medicine and Science in Sports and Exercise. Vol. 32, No. 3, Supplement, 2000.