What are the signs and symptoms of foot drop caused by chronic compartment syndrome?

Updated: Mar 23, 2020
  • Author: James W Pritchett, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Chronic compartment syndrome occurs in athletes in their third or fourth decade who have exercise-induced pain in the lower leg or foot within 20-30 minutes after beginning to exercise. Often, this occurs after a recent increase in intensity or duration of training or after a change in the training routine. The symptoms resolve after 15-30 minutes of rest; however, as the syndrome progresses, pain occurs earlier and takes longer to resolve. The anterior compartment is the one that is most commonly involved.

Unless the patient has been exercising just before being examined, the physical examination may yield nonspecific or normal results. Patients with a chronic anterior compartment syndrome may have diminished sensation in the first dorsal web space.

Recording of intracompartmental pressures before, during, and after exercise can provide useful diagnostic information as to which compartments may be involved. The following, individually or in combination, are believed to be indicative of the syndrome:

  • Resting pressure of 15 mm Hg or higher
  • Pressure of 30 mm Hg or higher 1 minute after exercise
  • Pressure of 20 mm Hg or higher 5 minutes after exercise

A slit catheter may be used to measure these pressures, with the understanding that the accuracy of the readings is influenced by the depth of needle insertion; the positioning of the leg, ankle, and foot; and the force of muscle contraction.

Some preliminary investigation has been completed into the use of magnetic resonance imaging (MRI) as a potential test for chronic compartment syndrome.

Nonsurgical treatment of a chronic compartment syndrome can succeed only if the patient is willing to discontinue the inciting activity. The surgical treatment of choice is fasciotomy of the involved compartment.

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