The Center for Podiatric Care and Sports Medicine

Acute Compartment Syndrome of the Lower Limbs: Risk Factors and Treatments

Posted by on Monday, May 23rd, 2016

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Two years ago, lifelong athlete Tyson Goulding finished a 10K run, something he often did – but this time, the finish felt different. His right calf was aching and his symptoms worsened. He visited urgent care, where doctors told him he’d need emergency surgery immediately if he wanted to keep his leg. His ailment was “acute compartment syndrome.”

Acute Compartment Syndrome
Acute compartment syndrome is a danger for pro and amateur athletes alike and requires immediate treatment. (Image Credit: Flickr CC user John Martinez Pavliga)

NFL Athlete Rahim Moore Had Acute Compartment Syndrome Too

Denver Broncos’ Safety Rahim Moore had suffered the same injury complication in his left leg seven months prior. He, too, needed emergency surgery to prevent amputation. One of Goulding’s relatives reached out to the Broncos to see if an encouraging call or text from Moore would be possible. Within a half hour, the player was standing in Goulding’s hospital room.

“He was my example that you can get back,” Goulding recalled. Three months later, Goulding was walking, but not able to run yet. “I’ve been an athlete my whole life. I understand the work of working out and building muscle so I know it doesn’t happen overnight. I’m still working on it,” he reported.

He developed a special friendship with Moore, who invited him to practices, sent him game tickets, went to therapy with him, and cheered him on.

We love a good story of inspiration and recovery here at The Center For Podiatric Care and Sports Medicine. Not every patient with acute compartment syndrome has an NFL player in their corner, but we root for everyone we treat.

What Is Acute Compartment Syndrome?

A “compartment” refers to a bundle of muscles or organs protected by connective tissue called fascia. These bundles are found throughout your body, including your upper and lower limbs. WebMD describes the syndrome in simple terms: “After an injury, blood or edema (fluid resulting from inflammation or injury) may accumulate in the compartment. The tough walls of fascia cannot easily expand, and compartment pressure rises, preventing adequate blood flow to tissues inside the compartment. Severe tissue damage can result, with loss of body function or even death.”

Acute compartment syndrome most commonly accompanies a traumatic injury, but it sometimes also occurs as a complication of overuse injuries. As podiatrists, we generally treat lower extremities, like your legs or feet, but your thigh, arm, abdomen and buttock regions can also be affected.

Risk Factors for Acute Compartment Syndrome

In 75% of all cases, the root cause of compartment syndrome is a broken bone – which is why it’s so important to have fractures treated professionally. Those who suffer compartment syndrome usually need emergency medical treatment within hours or days, as pain and pressure quickly intensify.

There are a number of other factors that can also lead to compartment syndrome:

  • Compression or crush injuries.
  • Overly tight bandaging of extremities.
  • Severe ankle sprains.
  • Medication, including anticoagulant drugs and anabolic steroids.
  • Age (under 35) and gender (male).
  • Impact injuries, such as being hit by a baseball.
  • Bumping up mileage too quickly when running.
  • Adding interval speed work to an exercise routine before base training is established.
  • Extremely vigorous exercise (especially eccentric movements with weights).
  • Underlying conditions like myositis, fasciitis, strep A infections, or osteochondroma.

Symptoms of Compartment Syndrome

It’s easy to confuse the early signs of compartment syndrome with muscle cramps – but if you have a shin splint or a common calf cramp,  your pain usually subsides when you stop exercising. A tell-tale sign of compartment syndrome is long, lingering pain and numbness due to increased pressure and reduced blood flow in the affected areas. Tingling is another cue to seek medical attention right away.

Prognosis and Recovery

A good prognosis depends on early treatment. If your diagnosis is delayed until you have noticeably weak muscle function, permanent impairment, and nerve injury often occur, with only 13% of patients making a full recovery. Decompressive fasciotomy must be performed as an emergency procedure, with fracture stabilization and vascular repair often performed as well. Most of our patients will need three to four months of no running or vigorous exercise, and six months of total recovery time.

Prevention in NYC

In addition to cutting back on overly vigorous exercise, we advocate gentle stretching to warm up and cool down your muscle groups to help prevent compartment syndrome.

We also strongly encourage NY runners and athletes to seek shin splint treatment to prevent exercise-induced compartment syndrome. Our treatment options for shin splints include surgical release of the fascia to prevent nerve damage and tissue death, as well as an assessment of underlying biomechanics contributing to the overuse of the affected muscle group. Once these biomechanical aspects are identified, we can correct the imbalance with a change in footwear, alterations to running form, custom orthotics, physical therapy and Extracorporeal Shock Wave Therapy. Get in touch with us today for an appointment.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.