Lower Leg Lateral Chronic Exertional Compartment Syndrome: Prospective Surgical Treatment Outcomes for Isolated or Combined Lateral Fasciotomy

Aniek P M van Zantvoort, Johan A de Bruijn, Henricus P H Hundscheid, Joep A W Teijink, Marc R Scheltinga*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

46 Downloads (Pure)

Abstract

BACKGROUND: Chronic exertional compartment syndrome involving the lower leg lateral compartment (lat-CECS) seldom occurs isolated but is usually combined with CECS of the anterior (ant-CECS) or deep posterior compartment (dp-CECS). Patient characteristics in lat-CECS and outcome after surgery are largely unknown. The aim of this prospective case series was to describe patient characteristics and symptoms and to report on outcome following a fasciotomy. METHODS: All patients diagnosed with lat-CECS based on exertional lateral lower leg symptoms and elevated intracompartmental pressure (ICP) measurements according to the Pedowitz criteria (ICP?=?15?mm Hg at rest, and/or =30?mm Hg after 1?minute, and/or =20?mm Hg 5?minutes after exercise) were eligible for this study. A standard intake questionnaire scoring symptom patterns was completed by all patients. Patients who were operated for lat-CECS were asked to complete a 3-month and 12-month postoperative questionnaire scoring symptoms and surgical outcome. Patients with a history of CECS surgery, recent lower leg trauma, or peripheral neurovascular disease were excluded. RESULTS: A total of 881 patients with possible lower leg CECS completed an intake questionnaire and 88 (10%) were diagnosed with lat-CECS according to the Pedowitz criteria (isolated lat-CECS n?=?10; lat/ant CECS n?=?54, lat/ant/dp CECS n?=?19, lat/dp CECS n?=?5). Severe pain during exercise and moderate tightness during rest were frequently reported. A group of 28 patients (49 legs; isolated lat-CECS n?=?2; lat/ant CECS n?=?22, lat/ant/dp CECS n?=?3, lat/dp CECS n?=?1) was analyzed after fasciotomy. Complications were minor (wound infection requiring antibiotics, n?=?3; temporary complex regional pain syndrome with spontaneous recovery, n?=?1). Superficial peroneal nerve damage was not observed. One year after surgery, 64% rated outcome as excellent or good, whereas 71% had resumed sports activities. CONCLUSION: One in 10 patients with anterolateral exertional lower leg pain evaluated in a tertiary referral center met diagnostic criteria for lat-CECS. Pain and tightness were present during exertion and were often reported occurring during rest and at night. In this series, we found fasciotomy-either an isolated (lateral) or a multiple (combined with anterior and/or deep posterior) compartment fasciotomy-is safe and beneficial in most patients. LEVEL OF EVIDENCE: Level IV, case series.
Original languageEnglish
Pages (from-to)1097 - 1104
Number of pages8
JournalFoot & Ankle International
Volume44
Issue number11
Early online date19 Sept 2023
DOIs
Publication statusPublished - Nov 2023

Keywords

  • CECS
  • chronic exertional compartment syndrome
  • lateral compartment
  • lower leg

Fingerprint

Dive into the research topics of 'Lower Leg Lateral Chronic Exertional Compartment Syndrome: Prospective Surgical Treatment Outcomes for Isolated or Combined Lateral Fasciotomy'. Together they form a unique fingerprint.

Cite this