Compartment Syndrome Causes & Treatment

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Background

Every muscle in your lower leg is housed within one of four ‘compartments’, each surrounded by a connective tissue (fascia) sheath. This is similar to how the segments of a mandarin are enclosed. The compartments help keep muscles, nerves, and blood vessels in place, ensuring proper function and coordination as the muscles often work together to enable movement.
 
However, if swelling or bleeding occurs within a compartment, there is limited space for expansion. This causes an increase in pressure, which not only results in pain and discomfort but can also compress the nerves and blood vessels, leading to more serious complications. This condition is known as compartment syndrome.
lower limb diagram for compartment syndrome

Table of Contents

Acute Compartment Syndrome

Acute compartment syndrome is one of two types of compartment syndrome, and it is the more serious type with potentially severe consequences for the lower limbs. It often requires emergency medical attention, so it is crucial to consult your doctor or podiatrist immediately if you suspect you are experiencing this condition.

 

Acute compartment syndrome typically results from trauma or injury, such as a car accident or severe sporting incident. The trauma causes bleeding within a muscle compartment, and due to the confined space within the fascia, the blood cannot effectively escape. This leads to a rapid rise in pressure, which compresses nerves and arteries, causing intense pain. Compressed nerves can result in muscle weakness, dysfunction, and altered sensation, while compressed arteries prevent blood and oxygen from reaching the cells. Without prompt treatment, this can lead to cell death and permanent damage, which is why acute compartment syndrome is considered a medical emergency.

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Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome (CECS) is the second type of compartment syndrome and is far more common than the acute form. While it isn’t a medical emergency, it can occur repeatedly, making treatment essential for prevention and long-term management.

CECS typically develops due to strenuous exercise. Increased blood flow during activity causes the muscles to expand temporarily, resulting in a painful rise in pressure within a compartment. This condition can affect one or both legs but is more common in the leading leg (the one bearing more stress, such as stepping up). The anterior (front) compartment of the leg is most frequently affected, which often leads to confusion with conditions like shin splints or stress fractures. A key diagnostic indicator is the timing of symptoms, which usually appear about 30 minutes into intense exercise like running.

Symptoms include increasing pain during exercise that may force you to stop, along with numbness, tingling, burning sensations, or pins and needles if nerves are compressed. You might also experience weakness, particularly in lifting your toes towards the sky (dorsiflexion). Fortunately, CECS symptoms generally subside after stopping exercise and when blood flow returns to normal resting levels.

Treating Compartment Syndrome

While acute compartment syndrome requires urgent surgical intervention to relieve the pressure and prevent permanent damage, chronic exertional compartment syndrome (CECS) can often be managed effectively by addressing the underlying causes. Our team takes a tailored approach to each case, conducting a thorough assessment of your foot and leg biomechanics, gait, training routines, and footwear. Management strategies may include:

  • Adjusting your training schedule or technique, including changes to the running surface where relevant.
  • Gait retraining to improve movement patterns and reduce stress on the affected compartments.
  • Custom foot orthotics to modify muscle function in the feet and legs, reducing strain and improving biomechanics.
  • Footwear assessment to ensure your shoes support healthy foot function and don’t contribute to CECS symptoms.

Until you can consult your podiatrist, it’s important to avoid activities that trigger symptoms to prevent exacerbating the condition.

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