Compartment Syndrome (Acute and Chronic Exertional Compartment Syndrome)
The anatomy behind compartment syndrome
Compartment syndrome occurs from increased pressure in a muscle compartment. The muscles of the legs are separated into compartments and are surrounded by a connective tissue (fascia). This fascia keeps the muscles together in the compartment so does not allow for much stretch. Alongside muscles, these compartments also contain nerves, blood vessels and connective tissues.
The muscles in each compartment work together to produce movement. The lower leg is separated into four compartments:
- Anterior compartment
- Lateral compartment
- Superficial posterior compartment
- Deep posterior compartment
What happens in compartment syndrome?
This syndrome occurs when the pressure within a muscle compartment exceeds what is normal. As the compartments are not designed to expand, the muscles, blood vessels and nerves within the compartment are compressed. This can restrict circulation, nerve and muscle function, and can cause a large amount of pain for those affected.
There are two primary types of compartment syndrome: acute and chronic exertional compartment syndrome. They’re distinguished by the cause of the pressure increase. It’s important to diagnose and manage this condition promptly as restrictions in blood flow and oxygen can cause tissue death.
What causes compartment syndrome?
Acute compartment syndrome occurs following trauma or injury that results in bleeding and/or swelling in a compartment. These symptoms take up room in the compartment and can compress nerves and blood vessels to the point that they’re unable to perfuse the tissues effectively. Examples of injuries include fractures and muscle bruising, among others.
Chronic exertional compartment syndrome tends to affect physically active individuals. Strenuous or high-impact activities increase the blood flow to muscle groups and can cause swelling, thereby increasing pressure within the compartment. Running is a common example.
What are the symptoms?
Initially, symptoms to the affected compartment can include:
- Aching / Pain that worsens during exercise
- Tightness and/or cramping
- Numbness, tingling or burning (neural) sensations
- Impaired muscle function
- Pain subsides shortly after stopping the activity
If the pain worsens or doesn’t settle, the tissues may not be getting enough blood or oxygen, and should be seen to immediately. Athletes who suffer from chronic exertional compartment syndrome may develop ongoing pain and muscle weakness.
How is it treated?
Acute compartment syndrome must be dealt with immediately by your GP. This usually requires surgery. Chronic exertional compartment syndrome may be managed conservatively with your Podiatrist following a visit to your GP.
Symptoms may initially be managed with rest, ice, elevating the foot and limiting the activity that brought on the symptoms. Unfortunately, this doesn’t stop the problem from continuing to happen again. This is why the long-term focus must be on reducing the load on the tissues and therefore the swelling (and pressure). This can be done through modifying regular activities, working on gait retraining and techniques, looking at the biomechanics of your feet and the use of orthotics, checking your footwear, and physical therapy.