A more recent theory is that there is a fifth compartment which is made up only of the posterior tibialis muscle with its own fascial covering.The deep posterior compartment contains the tibial nerve, posterior tibial artery, peroneal artery, the flexor digitorum brevis, and the flexor hallucis brevis.The superficial posterior compartment contains the sural nerve, the medial and lateral heads of the gastrocnemius muscles, and the soleus muscle.The lateral compartment encloses the superficial peroneal nerve and the peroneus longus and brevis muscles.The anterior compartment contains the anterior tibial artery, deep peroneal nerve, extensor digitorum longus, anterior tibialis, and extensor halluces longus.Each compartment contains individual muscles, nerves, arteries, and veins, encased in its own fascial membrane. Historically, the lower leg has been described as four compartments. It is imperative to understand the anatomy in the evaluation, diagnosis, and treatment of chronic compartment syndrome. 2 Typically, this condition is seen in athletics that require running and jumping thus leading to increased intramuscular pressure during training or competition.Īcute compartment syndrome, which is often seen in fractures or crush injuries to the extremities, represent emergencies and are outside the scope of this article. Incidence ranges from 14% to 39% in the general population presenting with leg pain. While it is most commonly seen in the lower leg, it has been described in the shoulder, arms, hands, thighs, and feet. It is thought to lead to reduced blood flow and tissue perfusion and is associated with repetitive exertion. Osseous spaces and the anatomic compartments. 1Ĭhronic compartment syndrome is caused by increased pressure within the closed fibro. There is typically a 22-month delay in the diagnosis and treatment of chronic compartment syndrome and popliteal artery entrapment in patients, and that delay could be detrimental to their athletic career. Exertional chronic compartment syndrome is not a common diagnosis however, it is one that is commonly overlooked. Lower leg pain experienced by athletes is typically posterior tibial tendonitis, shin splints, stress fractures, or Achilles tendonosis. A physician must be aware of many causes of lower extremity pain in these patients. Leg pain in the active and athletic patient population can be difficult to evaluate, diagnose, and treat. With an average 22-month delay in diagnosis, suspicions need to be elevated sooner. By Hayley Iosue, DPM, Joseph Albright, DPM, and Mark Mendeszoon, DPM Chronic compartment syndrome is an often-overlooked diagnosis in patients who are athletically inclined.
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