Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome (CECS) is a rare condition that usually affects distance runners and other running athletes. It is characterized by pain and pressure in one or multiple muscle compartments with repetitive physical activity. Reduction in pain typically occurs with cessation of activity. Evaluation of CECS consists of a thorough history of patient symptoms and ruling out of other causes of symptoms. Post-exercise pressure measurements can help confirm the diagnosis when symptoms are consistent and imaging evaluation negative for other causes. Non-operative treatment is a viable option for hindfoot runners and patients with anterior compartment syndrome of the leg.

All patients referred pain over the anterior/antero-lateral aspect of the leg after a well-defined period of exercise, generally 20 min (from 15 to 30). Symptoms always resolved after rest, within several minutes. At clinical examination, no patients complained of tenderness of the tibial shaft or surrounding soft tissues. Plain radiographs were undertaken to exclude a tibial stress fracture and other bony disorders.

Limited-incision fasciotomy has been shown to be the most effective treatment and remains the gold standard for treatment. Minimal-incision open fasciotomy and endoscopic fasciotomy have surgical outcomes similar to wide-open fasciotomy. Military patients treated with fasciotomy have higher failure rates compared to civilians. Pediatric patients have similar outcomes compared to adults.