It is a compartment syndrome - the tibialis anterior muscle swells with exercise producing relative muscle ischaemia as the muscle expansion is restricted by the non expansile fascial compartment - may be numbness of the big toe.
CECS may be difficult to diagnose, but it is most commonly affects the anterior compartment
Anterior compartment of lower leg (1):
CECS is a condition of increased pressure in the fascial compartments (muscles and neurovascular structures bound by fascia and bone) related to exercise leads to recurrent episodes of pain
symptoms are bilateral 85% to 95% of the time
pathophysiology of CECS is multifactorial. Factors may include (2,3,4):
constraints of a fixed muscular compartment, normal or abnormal muscle swelling that occurs with activity, abnormally thickened fascia, normal muscle hypertrophy in response to resistance training, or dynamic contraction patterns during gait
low muscle capillary supply is a pathogenic factor in chronic compartment syndrome
CECS is prevalent equally in both sexes with a median age of onset of 20-years-old and is associated with diabetes mellitus
CECS: Compartment Pressure Testing (5)
compartment pressure testing is the gold standard for CECS
preexertional and postexertional measurements are needed
the postexertional measurements should be taken within 5 minutes of the exercise; the athlete should be symptomatic at the time of measurement
a positive compartment pressure test is a preexercise resting pressure of 15 mmHg or greater and/or a 1-minute postexercise pressure of 30 mmHg or greater and/or a 5-minute postexercise pressure of 20 mmHg or greater
Reference:
Faez M. The anatomy of the leg. SlideShare.
Brennan FH, Kane SF. Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome. Curr Sports Med Rep. 2003;2:247-250
Raikin S, Venkat R, Vitanzo P. Bilateral simultaneous fasciotomy for chronic exertional compartment syndrome. Foot Ankle Int 2005; 26: 1007-1011
Shah S, Miller B, Kuhn J. Chronic exertional compartment syndrome. Am J Orthop 2004; 33: 335-341
Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990;18:35-40.
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