Hi,
I was trying to roll through all the threads about compartment syndrome and decided just to start my own. My “journey” started one week after a race in November 07. It started with burning in both ankles and a bit of lower leg. I was diagnosed with achilles tendonitis- then with tarsal tunnel, then with nerve entrapment and finally…after many physios and doctors one neurologist asked if I had ever been tested for compartment syndrome. At that point I was having nerve pain in both legs, mostly in the left. My toes would sometimes get very painful and it would be hard to move my foot up and down. Even put weight on it somedays. So I had the test in my anterior compartment only and it was a reading of 47 (after 20 something minutes of running). Mind you, I never felt that much pain on that day and he couldn’t understand how I wasn’t in more pain with that reading…I have never had shin pain really. My legs get feeling “full” and tight and fatigued. Then there is the toe pain some days and pins and needles in the bottom of my feet and ‘buzzing’ in my legs. At this point I also find my legs can get ‘cold’ easily and kind of ache. I have been at this nightmare for 14 months now. I have a surgery consult early March.
My worry is that my sport doc just shakes his head at some of my symptoms…he says I am atypical and usually compartment syndrome is very clear cut. Walking on uneven ground can set me off, never mind running. Although when I was in Mexico for a vacation I found I could run a bit on the treadmill. Nothing horrible happened, just some pins and needles on the bottom of my feet. Someone said this might have to do with temperature and being at sea level…?
So I am concerned about whether I am headed toward the right solution. The only thing that seems to help sometimes is IMS - the needles help release some pressure. I find my pressure can really hang around…and cause night pain.
Anyone out there ever experienced any of this- and anyone have any comment about whether it does or does not sound like compartment syndrome to them? Any advice is appreciated!
April
I would think if the compartment pressure test came back positive then it’s a fairly clear cut diagnosis. But I am surprised that your doctor only tested one of the compartments and not all compartments, since you could have elevated pressure in more then one. Also, you mentioned issues with both legs - were both legs tested? To me it does sound like compartment syndrome - but I’m not a doctor. I’d say your symptoms do sound like either compartment syndrome, nerve entrapment, or possibly a vascular issue but since you already have shown to have elevated pressure with exercise I’d say compartment syndrome is most likely. You said you went to a neurologist - did he/she do nerve conduction tests? If you’re not completely comfortable with the diagnosis maybe you might want to try to find another ortho to get a second opinion? If it were me I would want all compartments in both legs tested to make sure if I had surgery they release all the compartments that have elevated pressures. Good luck!
with a reading that high, by definition you likely have compartment syndrome. However, your symptoms also fit with one of your earlier diagnoses as well (tarsal tunnel syndrome). I suppose you could have both with the compartment syndrome causing the tarsal tunnel type symptoms. Hopefully, after your release (it sounds like you are going that way) both issues will clear?
You mentioned you saw a neurologist, was an NCV/EMG done? Although, it it was, they are often negative if not done during an increase pressure episode.
Your symptoms were different than mine as far as what you’re feeling in your ankle and pins and needles. However, it sounds exactly what I experienced in my outer shin - tightness, feeling pressure in the muscle, loss of motor control and inability to raise my toes up, a dull pain, etc.
I had surgery on both legs and within a week I was doing short runs with no pain whatsoever. It has been two years since my surgery and I have never had compartment syndrome problems again.
If you do have surgery and start running again, be sure to ramp up slowly. My fitness was good from my swimming and cycling, so once I was able to run again I ran long and far. It felt great until I started having shin splint problems. I had never had shin splints before, but I still struggle with them now. I’m convinced it is because I ramped up my running too aggressively after my surgery.
Not sure if this info will help you or not. Best of luck in getting it sorted out.
Yes, I had a nerve and muscle conduction study done- nothing of interest. She said no damage to the major nerves, but the test does not get at the smaller nerves.
Another strange thing with me that docs scratch their heads at…I cannot tolerate any massage on my calves. By the next day I have bands of tightness develop, pressure seems to go up and sometimes end up with the toe pain as well. One doctor speculated that massage was bringing enough blood to the area to induce swelling…
don’t know if this helps- but my pressure readings were over 20mmhg at rest and over 80mmhg after 5min treadmill running before my doc and I agreed it was CS. I never had neurological issues in the legs, but ‘fullness’, pins and needles and getting ‘cold’ were very much present in my forearms (I also had CS in my forearms due to rowing)
Best of luck with your injury! Hope you get it sorted out soon
This seems to be a prevalent injury on this board. I am going through this now. Posted a while back on it. Might be some good info for you in there and other posts on ST. Do a search, there is a ton of info out there on this injury.
Any ways, my doctor only tested one compartment as well. Like you I thought that was odd, but given the symptoms being the same in both legs, and all around the calves, shins, etc I think it is enough to lead to a good diagnosis. I’ve been at this for almost 3 years (and 30 pounds ) so I understand your frustration. Finally scheduled to have the surgery on Wednesday (bilateral fasciotomy w/ 3 compartment release in each leg).
Good luck with this. Sounds like you’re on the right track and faster than a lot of us who struggle to figure out what is going on.
My family doctor waffled quite a bit in helping me deal with my CS. However, when I went to a sports clinic and saw a doctor who works regularly with athletes they diagnosed me immediately and scheduled me for surgery. Interestingly enough, the sports docs diagnosed and scheduled my surgery without ever having my pressure testing done. They felt confident enough just watching me run and by doing a couple of physical tests with me.
Yes, I am going to a sport med clinic at the university. But he said that I am the strangest case of CS he has ever seen…because I have night pain and can’t tolerate massage. He said usually CS is straight forward- you run, you are in pain. You stop, you are out of pain. Not so for me, as just walking on uneven ground can set me off. And once my pressure is high, it can low really linger…but that is 15 months into it at this point. Earlier on it was not this bad. Now I can’t even light bike or light row without my legs getting “full”.
What about the vascular angle? If you have a veinous return issue that could cause all the same symptoms plus it could be fatal due to DVT causing a pulmonary embolism. Did you have doplar imaging done of the lower legs to check for clotting?
Thanks for all your comments everyone. I finally have a surgery consult March 10th- which seems so far away still. I am in agony tonight. The pressure seems to be staying high again…fullness, tightness, tingling and sore toes…
If there was a do your own fasciotomy.com I might just be there now!
I want to ask you if you’ve been evaluated for DVT? These are classic symptoms of a blood clot and as far as I know (not being a Dr.) it’s one of the first things that should have been ruled out. Since it’s a dangerous condition I just wanted to find out.
Hi,
No that has never come up…I would think though that blood clots would present slightly different? It just seems the farther I get along with this (on the 15th month) the less it takes for pressure to elevate and the longer it lingers. I know that is not typical, but I did read of it on one site I found. I will ask my doc about the blood clots when I see him on Friday.
Thanks!
They say that if you have a DVT you have a 3% chance of death due to Pulmonary Embolism. I am not the alarmist type, but just think it’s important to rule it out first whenever someone has any lower leg pain especially when the pain can be described as ‘pressure’.
They say that physical examination isn’t conclusive. You need doplar imaging to rule it out.
I just survived a pulmonary embolism last summer so I’m on the lookout for it I guess. I do think that there is a risk factor among runners/triathletes that the medical community doesn’t yet know about. Also women are more prone because birth control pills increase the risk of clotting.
Because of the chronicity of her symptoms (14 months) and the on/off pain - that history alone would put a popliteal DVT way down on the differential based on history alone.
Now, with hands on via several docs (always the deferred method, even with “bad” docs) we can likely assume no erythema, increased warmth, etc. that would raise the index of suspicion. But …
If you are referring to DVT, then I’m pretty sure that the duration rules it out. My understanding from my conversations with my Drs is that blood clots won’t/can’t persist that long.
) so I understand your frustration. Finally scheduled to have the surgery on Wednesday (bilateral fasciotomy w/ 3 compartment release in each leg).