measures have been implemented, but only with short-term benefit (31) and in most cases never achieving the ultimate goal. Conservative treatment may address the following: footwear, training surface, intensity and level of activity, abnormal biomechanics, core stability issues, neuromuscular involvement and training errors. As part of conservative management, non-steroidal anti- inflammatory drugs (NSAIDs), analgesics, heat, ice, rest, ultrasound, physiotherapy, acupuncture, steroid injections, foot orthoses, osteopathy, deep massage, trigger point work and homeopathy have been used, but they have been found to have only short-term benefits and poor long-term success.

CONCLUSION Chronic compartment syndrome is a physiological condition that is relatively common among endurance athletes. Diagnosis is based on detailed history and supported by elevated intracompartment pressure study. The most definitive treatment is surgical decompression allowing a better prognosis for the athlete to return to sport.

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lower leg syndrome. Acta Orthopaedica Scandinavica 1979;50:573–581 11. Detmer DE, Sharpe K, Sufit RL, Girdley FM. Chronic compartment syndrome: diagnosis, management and outcomes. American Journal of Sports Medicine 1985;13:162– 170 12. Allen MJ, Barnes MR. Exercise pain in the lower leg. Journal of Bone and Joint Surgery 1986;68B:818–823 13. Hargens AR, Akeson WH, Mubarak SJ, Owen CA, Evans KL, Garetto LP, Gonslave MR, Schmidt DA. Fluid balance within the canine anterolateral compartment and its relationship to compartment syndrome. Journal of Bone and Joint Surgery 1978;60A:499–505 14. Qvarfordt P, Christenson MD, Eklof B, Ohlin, Saltin B. Intramuscular pressure, muscle blood flow and skeletal muscle metabolism in chronic anterior compartment syndrome. Clinical Orthopaedics and Related Research 1983;179:284–290 15. Wallensten R, Eriksson E. Intramuscular pressures in exercise induced lower leg pain. International Journal of Sports Medicine 1984;5:31–35 16. Whiteside TE, Hirada H, Morimoto K. The response of skeletal muscle to temporary ischaemia: an experimental study. Journal of Bone and Joint Surgery 1971;53A:1027 17. Heppenstall R, Sapega I. Compartment syndrome: a quantitative study of high energy phosphorous compounds using magnetic resonance spectroscopy. Journal of Trauma 1989;29:1113–1119 18. Beckham SG, Grana WA, Buckley P, Breazile JE, Claypool PL. A comparison of anterior compartment pressures in competitive runners and cyclists. American Journal of Sports Medicine 1993;21:36– 39 19. Wiley JP, Clement DB, Doyle DL, Miller SD. A primary care perspective of chronic compartment syndrome of the leg. The Physician and Sportsmedicine 1987;15:111–120 20. Amendola A, Webster-Bogaert S. Diagnostic criteria for the exertional compartment syndrome. Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, 1995, Orlando, FL, USA 21. Styf J. Chronic exercise induced pain in the anterior aspect of the lower leg: an overview of diagnosis. Sports Medicine 1989;7:331–339 22. French EB, Price WH. Anterior tibial pain. British Medical Journal 1962;2:1290– 1296

23. Padhiar N, King JB. Exercise induced leg pain: chronic compartment syndrome. Is the increase in intra-compartment pressure, exercise specific? British Journal of Sports Medicine 1996;30:360–362 24. Styf J, Korner L, Suurkula M. Intramuscular pressure and muscle blood flow during exercise in chronic compartment syndrome. Acta Orthopaedica Scandinavica 1987;58:139–144 25. Amendola A, Rorabeck CH, Vellett D, Vezina W, Rutt B, Nott L. The use of MRI in exertional compartment syndromes. American Journal of Sports Medicine

Youtube playlist on compartment syndrome

1990;18:29–34 26. Jenner J. Personal communication, 1994, Cambridge, UK. 27. Martinson H, Stokes MJ. Measurement of anterior tibial muscle size using real time ultrasound imaging. European Journal of Applied Physiology 1991;63:250–254 28. Young D, Hughes I, Russell P, Parker MJ, Nicholls PJR. Measurement of quadriceps muscle wasting by ultrasonography. Rheumatology and Rehabilitation 1980;19:141–148 29. Abramowitz AJ, Schepsis AA. Chronic exertional compartment syndrome of the leg. Orthopaedic Review 1994;23:219– 226 30. Turnispeed W, Detmer DE, Girdley. Chronic compartment syndrome: an unusual cause of claudication. Annals of Surgery 1989;210:557–563

31. Styf JR, Korner LM. Diagnosis of chronic anterior compartment syndrome in the lower leg. Acta Orthopaedica Scandinavica 1987;58:139–144

online Videos

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THE AUTHORS

Dr Nat Padhiar, MSc PhD FCPodS, graduated in podiatry from Chelsea

, M

graduated in podiatry from Chelsea School and pursued a career in podiatric sports medicine and podiatric surgery. In 1989

he was awarded a research-based MSc. In 1993 he became fellow of the Surgical Faculty, College of Podiatrists. In 1999 he was awarded a PhD in the field of orthopaedics and sports medicine from St Bartholomew’s and the Royal London School of Medicine and Dentistry, Queen Mary College, London University. In 1997 he was given a gold award for his presentation at the Scientific Meeting of British Association of Sports and Exercise Medicine. The presentation was in the field of chronic compartment syndrome, which was the basis of his PhD thesis. He holds a dual consultant podiatric surgeon post at

the Royal London Hospital (BLT) in the Musculoskeletal and Surgical Directorate and also at the Mile End Hospital (THPCT) in the Foot Health Department. He was recently made an honorary member of the European College of Sport and Exercise Physicians.

sportEX medicine 2009;40(Apr):16-22