Complaint
The symptoms of chronic compartment syndrome (CCS) depend on which compartment is involved. The compartment syndrome of the anticus lodge is the most common. Complaints that occur are pain and stiffness next to the tibia at the front of the lower leg. This pain occurs after less than 30 minutes of exercise. Tingling or numbness is also sometimes noticed around the big toe and the toe next to it. The complaints decrease with rest, and can be aroused by raising the foot.
In lateral compartment syndrome, burning pain occurs on the outside of the lower leg with numbness towards the ankle and on the top of the foot.
If the deep posterior compartment is involved, pain is felt on the inside of the tibia. The pain may radiate to the inside of the foot. Sometimes people complain about a feeling of fullness in the calves and calf cramps.
The compartment syndrome of the superficial posterior compartment is rare. The complaints are vague and difficult to localize. Sometimes there are nocturnal cramps in the calf.
In acute compartment syndrome, very severe pain in the lower leg is prominent, and the big toe or foot cannot be moved properly. This image requires urgent surgical intervention. This disease is not further discussed in this folder.
Sports in which chronic compartment syndrome is reported more often are running, skating and walking. It also occurs in people who suddenly have to walk much more than they were used to before, for example soldiers.
Condition
There are different muscle groups in the lower leg that enable the different movements of the lower leg, ankle and foot. The muscle groups are surrounded by a fascia, through which blood vessels and nerves also run. This unit is called a muscle compartment.
During exercise, the muscles often swell slightly. However, the fascia does not give way, so that the pressure within the fascia increases and blood vessels can become compressed. The blood supply to the tissues is reduced and the nerves send fewer impulses, so that the muscle group in question functions less well. This picture is called a compartment syndrome.
Causes
A number of underlying factors can contribute to the development of a chronic compartment syndrome. The complaints can be the result of properties related to the body (= intrinsic), but environmental factors (= extrinsic) can also play a role. Often, not one factor is responsible for the development of the complaints, but a combination of several.
Intrinsic:
- Overpronation: this involves walking more on the inside of the foot, for example due to foot shape deviations
- Diabetes mellitus: Research has shown that people with diabetes have higher compartment pressure compared to non-diabetics. In addition, it appears that they have a thicker fascia
- Venous vascular disease: if the vessels in the leg do not work properly, engorgement occurs. As a result, the fibers of the fascia are damaged and it loses flexibility and elasticity
- Insufficient stability of the lower leg muscles: instability can lead to overload of certain muscle groups, forcing them to work harder and causing more swelling
- Poor running technique: heel landing puts more strain on the ancus lodge
Extrinsic:
- Sudden increase in training load (intensity and/or duration)
- Wrong footwear: shoe stability is mainly determined by the heel cap and the sole. The sole must suit the foot type, gait, gait and weight of the runner. The wrong shoe can lead to a wrong gait. Old, worn-out shoes are also less stable, have less cushioning, and are often worn crookedly, which negatively affects foot gait
- Walking on a hard surface
Treatment
Correcting intrinsic and extrinsic factors is a first step. For example, by fitting a sports arch support, adjusting footwear and surface, and improving running technique. With a midfoot or forefoot landing, the anticus lodge is more spared.
Exercise therapy in combination with massage:
One weekly massage in combination with exercises for the calves twice a day extends the pain-free period during weight bearing.
This includes stretching exercises for the calf muscles, and exercises aimed at improving the strength and stability of the foot and calf muscles.
Operation:
If the complaints have existed for more than 12 months and the above therapeutic options have had no effect, an operative treatment can be chosen. Two possible operations are:
- Fasciotomy:
The fascia is split, so that the muscles have more space - Fasciectomy:
In this procedure, the fascia is partially removed. This technique is more often used in a previous fasciotomy without result.
Success rates are between 50 and 90%, depending on which compartment is operated on.
Compartment syndrome and sport
In the early stages, reducing the training load may be sufficient to allow the injury to heal. Think of a reduction in training duration and (walking) intensity. By looking for other forms of movement, the condition can be maintained. During sports such as cycling, aqua jogging or stepping, the calf muscles are not overloaded.
Once the complaint has disappeared and the causal factors have been addressed, the original sports activities can be resumed. Full recovery is the best way to prevent a recurrence. The training intensity should be built up slowly and within the pain threshold.
Preventing
The risk of compartment syndrome can be reduced by paying attention to the following:
Certainly at the start of the season or when returning from an injury, training too much, too often, and too heavily is a pitfall. A good training structure is important, whereby the scope of the training is first expanded (the number of hours) and only then the intensity.
Due to its damping effect, forest soil is an ideal surface to walk on, especially when you are just starting to walk.
Choose sports shoes that are suitable for the personal running style and foot shape. Good advice from the specialist shop is very valuable here. The average life of a sports shoe is 500 to 750 kilometers. After this, it quickly loses its shock-absorbing effect.
Sometimes the body has certain shortcomings (think foot shape abnormalities) that can cause an injury. When these are recognized and corrected in time, unnecessary injuries can be prevented.
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