Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome (CECS) is a disorder that typically presents as bilateral lower leg pain during exercise but is absent at rest. This is due to compression of a fascial compartment causing pain during exercise. It commonly presents in primary care but is often under-diagnosed due to a lack of awareness of the ailment by both patients and practitioners. If left undiagnosed it can lead to ischaemia and then infarction of the affected muscle compartment.

Treatment:
Chronic exertional compartment syndrome treatment can be through by either by surgical or non-surgical. The non-surgical can be Physical therapy, orthotics (inserts for shoes) and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms. Some athletes have symptoms that are worse on certain surfaces (concrete vs. running track, or artificial turf vs. grass). Symptoms may be relieved by switching surfaces. If the conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell.

Major research on disease:
An athlete can have reoccurrence of compartment syndrome after having a fasciotomy. The rate of reoccurrence is 6–11%, most patients, who fail treatment initially, have resolution of symptoms with a second more extensive fasciotomy. As insights are gained into the etiology of compartment syndrome pain, a greater diversity of treatment options for CECS will be available. The only definitive treatment currently is fasciotomy. Improved awareness of CECS by both providers and athletes may result in earlier intervention and a higher success rate of conservative therapy.