​ASKPHYSIO

Thick layers of tissue, called fascia, separate groups of muscles in the arms or legs. Inside each layer of fascia is a confined space, called a compartment that includes muscle tissue, nerves & blood vessels.

Compartment syndrome occurs when increased pressure compresses the blood vessels and nerves, resulting in decreased blood flow.  Reduced blood supply causes pain and can lead to tissue damage.

There are different types of compartment syndrome:

• Acute (following trauma)

• Chronic (Exertional) – deep posterior, anterior, or lateral

• Chronic which then becomes Acute

Deep posterior compartment of lower leg Contains the following muscles (flexor digitorum longus, flexor hallucis longus, tibialis posterior).  The tibial nerve is also contained within this compartment. 
Note:  the gastrocnemius and soleus (calf) muscles are superficially located and not typically affected.

Anterior compartment of the lower leg Contains the following muscles (tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius).  The deep peroneal nerve is also contained within this compartment.

Lateral compartment of the lower leg Contains the following muscles (peroneus longus, peroneus brevis).  The superficial peroneal nerve is also contained within this compartment.

Deep posterior compartment syndrome

• Ache in calf or medial tibia

• Pain which continues once exercise has stopped

• Tightness or burning sensation

• Pain on toe flexion or foot inversion

• Weakness

• Pins and needles

• Possible palpable muscle herniation

Anterior compartment syndrome

• Pain on the anterolateral border of the tibia

• Pins and needles or numbness in between the big toe and the 2nd toe

• Possible palpable muscle herniation

Lateral compartment syndrome

• Pain in front of the fibula (outer lower leg bone)

• Pins and needles and numbness on top of the foot

• Possible palpable muscle herniation

Acute compartment syndrome

In an acute case of compartment syndrome the hallmark symptom is severe pain that does not subside, even with pain medications. In addition they may also have tensely swollen, shiny skin and pain on compression of the area.

• Acute compartment syndrome is often associated with trauma as from a car accident or crush injury. It may also occur if you wear a bandage or a cast that is too tight.

• Chronic compartment syndrome can be caused by repetitive activities, such as running, which increases the pressure in a compartment.  The fascia is a structure which does not give, so fascial tightness is a key contributor.

Chronic deep posterior, anterior, lateral compartment syndrome

• Rest or reduction in aggravating activities

• Referral likely previously made, but if not already seek medical or physiotherapy assessment

Acute

• Permanent nerve injury and loss of muscle function can result if diagnosis is delayed.

Pressure testing on the compartment should be conducted to ascertain the effect of exertion (exercise) on the pressure within in a compartment.

Chronic compartment syndrome (posterior, anterior and lateral):

If conservative management fails, and pressure within the compartment remains high, then surgery would be indicated.  Options include fasciaectomy or fasciotomy.

Acute compartment syndrome

Acute compartment syndrome often occurs following trauma, and in some cases following exertion or overuse.  If pressure is not relieved with rest then it becomes a surgical emergency.

Your physiotherapist may be able to identify the problem as compartment syndrome.

They can implement the following conservative management:

• Deep soft tissue massage

• Deep transverse frictions

• Dry needling

• Myofascial stretching

• Assess lower limb biomechanics to address any contributing factors

• Review training program and suggest modifications

• Reduce the heel height of the shoe to decrease the strain on the anterior compartment muscles

If suspected they should also refer you for compartment testing.