Compartment Syndrome

What is compartment syndrome?

Compartment syndrome is a condition in which the pressure in certain area of the body increases due to some underlying condition. Most of the time the pressure is increased because of a crushing injury, but it can also be secondary to a variety of other problems. Compartment syndrome caused by a crushing injury can be limb threatening and may be a medical emergency.

What is exercise induce compartment syndrome? (Exertional compartment syndrome)

Exercise induced compartment syndrome is due to increased levels of activity causing an area of the body to swell and increase pressure within that area. Repetitive activities such as running, biking, walking, and any other activity with repetitive motions can cause this. Symptoms typically disappear within 30 minutes of stopping the activity. This is not a medical emergency but for active people these symptoms can be a major nuisance.

What are the signs and symptoms of exertional compartment syndrome of the foot and leg?

Pain and swelling can be seen as well as aching, tightness, numbness, weakness and foot drop of the affected limb. The symptoms will not subside until the activity that is causing the symptoms is stopped. It will get worse with increased activity and may persist for a day or two depending on the severity of the symptoms.

Why does compartment syndrome cause these symptoms?

The symptoms occur because when the pressure increases within a compartment of the foot/leg the nerves and blood vessels in the area are compressed. This compression of these structures can cause restrictive blood flow to the area and also cause damage to the nerves. The longer this phenomenon lasts the more damage can occur.

How do you treat exercise induced compartment syndrome?

The simple answer is to stop the activity immediately. Soon after stopping the activity the feet should feel normal. Compression stockings sound counter intuitive but they can be used to help push fluid out of the foot and ankle to reduce the risk of increased pressure. This solution is used if the compartment syndrome is due to venous congestion/insufficiency. Custom orthotics can be used to stop the arch of the foot from falling. When your arch collapses, this puts more strain on the tarsal tunnel which is a compartment that is often subjected to high pressures. Inside of this compartment is an artery, nerve, vein and several tendons. If this area becomes highly pressurized the symptoms mentioned above will occur. Cortisone injections to the area of high pressure can also benefit to help reduce swelling to the area.

Is surgery an option to fix this problem?

Yes, if the person is unwilling to change their exercise habits then a fasciotomy would be the next step. A fasciotomy is where soft tissue bands within the compartment of the body are released to allow expansion of the area. When there is room to move, this decompresses the compartment and can improve symptoms. The risk with the surgery is that it can reoccur because the body may scar at the site of the fasciotomy and will then not be able to relieve the pressure. Fasciotomies, if done properly, are highly effective, but again surgery is used as a last resort.

Can compartment syndrome be limb threatening?

Yes but this is typically when it is due to a major trauma. For example, if the leg bones were broken and major swelling occurred, the compartments within the leg may be too highly pressurized and this can cause blood flow to stop, giving rise to gangrene of the foot. This is obviously an emergent situation and rapid decompression of the compartment via fasciotomy would be necessary.

Exercise induced compartment syndrome has some serious symptoms but stopping of the activity will help dramatically.