Posterior Deep Compartment Syndrome

The deep posterior compartment is a surrounded by a sheath which contains the muscles in the lower leg. Compartment syndromes arise when a muscle becomes too big for the sheath that surrounds it.

Symptoms

Posterior compartment syndrome can be acute or chronic. An acute injury will be from an impact or contusion resulting in pain and restricted movement of the ankle. A chronic compartment syndrome will cause deep aching pain in the lower leg which comes on during a run, goes away with rest only to return when training resumes. There may also be pain when pulling the foot and toes downwards against resistance. Sometimes a foot drop is seen with significant weakness lifting the foot when walking.

Causes

Compartment syndromes can be acute or chronic. An acute compartment syndrome is caused by impact or trauma which causes bleeding within the muscle compartment and therefore swelling. Pressure inside the compartment is raised resulting in pain. A muscle strain can also bleed within a muscle compartment having the same effect.

A chronic compartment syndrome is usually comes on over a longer period of time and is a result of over use. The muscle grows too big for the compartment or sheath that surrounds it increasing pressure within the compartment and causing pain.

Biomechanical factors such as over pronation where the foot rolls in or flattens too much when running can abnormally increase the load on certain muscles making a compartment syndrome more likely.

Treatment

What can the athlete do?

Rest, but try to exercise your upper body or cycle if it is not painful. Apply ice or cold therapy for 20 minutes at a time but not directly onto the skin. Place in a wet tea towel. Commercially available hot and cold packs are often more convenient to use on a regular bases.

What can a sports injury specialist or doctor do?

For an acute compartment syndrome a doctor may prescribe anti-inflammatory medication e.g. ibuprofen to help reduce pain and swelling. Always check with a doctor before taking medication.

A chronic compartment syndrome may respond to massage techniques. Cross friction massage to the muscle compartment may have the effect of stretching the sheath creating more space for the muscle.

A full gait analysis can be done to analyze running style and any biomechanical dysfunction of the foot can be corrected with orthotic inserts. These are placed into the shoes and correct the motion of the foot which in turn will reduce the load on certain muscles in the lower leg.