Compartment Syndrome of the Lower Limbs

Compartment syndrome refers to an elevation in interstitial pressure within a closed osteofascial compartment that can ultimately result in irrevocable peripheral nerve and muscle ischemia.

There are two types of compartment syndrome that can occur in both the upper and lower extremities – acute and chronic.

Acute compartment syndrome of the lower extremity represents a surgical emergency which requires an urgent release of pressure from the affected region in order to prevent necrosis of the soft tissues or permanent disability.

Loreto Lollo and Andreas Grabinsky, from the Department of Anesthesiology and Pain Medicine at the University of Washington, highlight the importance of performing decompression fasciotomy to limit the severity of nerve injury and to protect the patient from serious consequences.

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Chronic compartment syndrome is an overuse injury of the lower extremity that causes a dull aching pain which intensifies with exertion in sports such as running or football. It is considered to be the most common cause of exercise-induced leg pain.

In a comprehensive study conducted on 123 patients with extremity muscle pain, swelling and paraesthesia, Islam and Robbs observed that the most commonly affected lower limb muscle groups were the anterolateral, deep posterior and superficial posterior compartments.

The authors described an increase of up to 20 percent in muscle volume and weight during strenuous exercise and a reduction in reserve volume within fascial compartment due to the normal muscular hypertrophy that occurs over time with chronic exercise.

Diagnosing chronic compartment syndrome can be challenging and requires invasive intra-compartmental pressure monitoring both pre- and post-exertion. This is necessary since during exertion, compartment pressures in patients with the condition increase drastically and take longer to return to their baseline.

While discussing the conservative management of two patients with bilateral soleus syndrome or chronic exertional compartment syndrome of the superficial posterior compartment, Gross et al. recommend the first line of treatment as lessening the intensity and frequency of activity.

This can be in conjunction with ice therapy and the use of non-steroidal anti-inflammatory drugs.

The authors also suggest modifications in footwear and wearing foot orthotics to gradually assist the patient in returning to their former level of functionality. This can be beneficial in minimising excessive pressure in the lower limbs while promoting normal ambulation during recovery.

Underlying biomechanical discrepancies such as a hyperpronated foot can further contribute to the development of lower limb pain as a result of abnormalities in movement; postural anomalies force the lower extremity to adapt by compensating for the lack of proper foundational support from the feet. 

As part of a comprehensive rehabilitative strategy for compartment syndrome coupled with a foot posture abnormality, MASS4D® foot orthotics act as pain-management devices to decrease any additional stress on the affected limbs by reinforcing the optimal movement of the lower extremity and preventing the chances of recurrences or injury.

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