Current Concepts Regarding the Diagnosis and Treatment of Chronic Exertional Compartment Syndrome of the Leg

Abstract

Leg pain is a common complaint in athletes, particularly in runners and those with repetitive impact.  While the differential diagnosis is broad, the most likely diagnoses in an athletic population include tendinopathy, stress fractures, medial tibial stress syndrome (MTSS), popliteal artery entrapment syndrome (PAES) and chronic exertional compartment syndrome (CECS). The first three usually have focal areas of pain at rest while the latter two are usually asymptomatic at rest but exacerbated with activities.  Patients with PAES develop pain in the posterior calf with exertion and may have a sensation of a warm flush to their feet when exercise ceases.  Dynamic arterial doppler analysis or magnetic resonance arteriography are usually used to confirm aberrant arterial flow or compression of the arterial inflow with exertion.  The purpose of this paper is to review recent conceptual challenges of both diagnoses and treatment of CECS of the leg.