INTRODUCTIONHere you'll find a general overview of the typical course of events related to compartment syndrome in the lower leg. It's important to remember that the diagnosis and treatment process can be different for everyone.WHAT IS COMPARTMENT SYNDROME?Muscles or muscle groups are surrounded by a capsule, a fascia. The strength of this capsule can vary. A muscle group surrounded by fascia is called a muscle compartment. At the front of the lower leg are several muscles that lift the toes and part of the ankle. These muscles are surrounded by a strong capsule, and this compartment is also called the anticussal compartment.
During intense exertion, muscles in a compartment can become too tight in their capsule due to swelling. This can lead to problems with blood flow and nerve supply. In extreme cases, the pressure can even become so high that the blood supply is cut off and the muscles partially die. Emergency treatment is then indicated.WHAT ARE THE COMPLAINTS?When the muscles in the anterior compartment are compromised after each exertion or exercise, this is called chronic compartment syndrome. The most common symptoms include pain or stiffness along the outer edge of the shin bone. Tingling or numbness around the first and second toes is also sometimes noted. Some swelling of the muscle compartment may also occur. In extreme cases, acute compartment syndrome, the pain is extremely severe, and the big toe or foot can no longer be moved properly. Other compartments in the affected leg usually become pinched as well.WHAT RESEARCH IS NECESSARY?Naturally, the doctor will first examine the lower leg itself. If compartment syndrome is suspected, an appointment can be made for a pressure measurement. It is possible to measure the pressure in a compartment. After disinfecting the skin, a thin needle is inserted through the skin, into the subcutaneous tissue and muscle capsule, reaching the muscle compartment. The pressure can be measured by injecting some fluid. In acute compartment syndrome, this resting pressure already provides sufficient information. If chronic compartment syndrome is suspected, the pressure is also measured after exercise.WHAT ARE THE TREATMENT OPTIONS?Treatment depends on the severity of the symptoms and, if applicable, the results of the pressure measurement.
If the symptoms could be consistent with chronic compartment syndrome of the lower leg, but the pressure measurement is normal, a wait-and-see policy is initially recommended. After a period of rest, an attempt is made to gradually train the muscle group, if necessary under physiotherapy supervision. If the symptoms persist and are very consistent with chronic compartment syndrome of the lower leg, surgery will likely be proposed in consultation with you.
If the pressure measurement indicates excessively high values during the symptoms, a wait-and-see policy will not be recommended, but surgical treatment will be proposed.
The surgical treatment consists of opening the tight muscle capsule (a so-called fasciotomy). This procedure is usually performed as a day clinic under general or spinal anesthesia. Through a small incision in the skin, the capsule is exposed and opened lengthwise.
In acute compartment syndrome, such surgery is required urgently. Often several muscle compartments have to be opened.POSSIBLE COMPLICATIONSNo procedure is without the risk of complications. This procedure also carries the usual risks of complications, such as thrombosis, pneumonia, postoperative bleeding, and wound infection.
Sometimes a bruise occurs at the site of the procedure, which usually resolves without problem and spontaneously. Infection of the surgical wound rarely occurs. Sometimes, scar tissue causes the fascia to become too tight again later, requiring further surgery.AFTER THE PROCEDUREWound healing takes one to two weeks. Initially, a dry, sterile, lightly compressive bandage is sufficient. If necessary, a simple painkiller (such as paracetamol) can be used for the pain. It is important to resume use of the leg as soon as possible, as this reduces the risk of the muscle capsule closing. Extreme exertion, such as intense sports or long marches, is not recommended during the first few weeks. No special lifestyle changes are necessary; you will get a feel for what you can and cannot do during the first few weeks. |
