A Missed Bilateral, Acute Anterior Exertional Compartment Syndrome of the Leg
January 15, 2021
A rare case of bilateral, acute exertional compartment syndrome due to vigorous exercise highlights the importance of appropriate early suspicion and treatment.
This case presents a bilateral, acute anterior exertional compartment syndrome of the leg and highlights the importance of high clinical suspicion and early treatment. Compartment syndrome can progress rapidly and urgently; therefore, the appropriate treatment is needed to prevent further muscle or nerve damage. Urgent fasciotomies create decompression of the tissue in the affected compartments to hopefully avoid late disability.
Brief Case Description
A 26-year-old male athlete presented to the University General Hospital of Larissa with bilateral leg pain as he over-trained and participated in two soccer matches. The athlete has a medical history of transient numbness and pain that coincides with rigorous exercise. This time, the severity of the pain continued and drop foot developed, making the patient unable to walk. Physical examination revealed that the athlete’s anterior compartment on both lower legs were swollen, tense, and painful on palpation during the plantar flexion of the ankle and toes. Due to the athletes delayed presentation to the hospital, he underwent three consecutive surgeries. At 13-months follow up, the patient has bilateral foot drop and walks with ankle and foot orthosis.
Intervention and Outcome Summary
Overtraining is a common cause of compartment syndrome. Previous studies have shown that endurance training for athletes and active military personnel are common causes of compartment syndrome. In this case, the athlete had strenuous training and did not rest properly. With a three-year clinical history of exercise induced anterior tibial pain and numbness on both lower legs, the patient is now scheduled for tendon transfers as he has no muscle strength in his right leg.
This case hypothesizes that the progression and severity in this instance was due to the vigorous exercise and lack of adequate rest as well as delay of diagnosis and appropriate treatment. Hospital admissions, surgical consultation, and clinical observation are recommended for any patient suffering continuous pain after an injury or exercise. Continuous monitoring (using the C2Dx Indwell Slit Catheter) is recommended for a repeated assessment every one-to-two hours to gauge compartment pressures and the proper diagnosis.
Fragkiskos A. Angelis, Antonios A. Koutalos, George Kalifis, Christina Aranaoutoglou, Michael Hantes