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Foot and Ankle

Exertional Compartment Syndrome


Exertional compartment syndrome is an overuse phenomenon that creates pain and limited function in the lower leg.  This is different from acute compartment syndrome which is typically directly related to significant trauma in the lower leg.  Exertional compartment syndrome happens when exercise causes the pressures to rise within the compartments of the lower leg limiting blood flow to the muscles and creating a cramping, painful sensation.


Pain is usually experienced when the compartment pressure rises within the leg interfereing with the normal muscle function.  In more significant cases decreased nerve and motor function may be experienced as they become compromised due to limited oxygen delivery.

Diagnostic Testing

Our physicians will perform an extensive physical examination including x-rays.  If exertional compartment syndrome is suspected further testing may be required. Often MRI or CT scan would be used to rule out a stress fracture.  The golden standard for assessment of compartment testing includes compartment pressure measurements done immediately after exercise (while symptoms are present).

These are typically not performed by our physicians and would require testing to be done prior to an office visit.


Non-Surgical Treatment for Exertional Compartment Syndrome

Treatment will vary according to the nature of the symptoms. If detected early a regime of rest and gentle therapy will be attempted. Changes in training may be needed.  Muscle imbalances may be identified and treated by our physical therapy team as proximal muscle weakness may contribute to exertional compartment syndrome.

Surgical Treatment of Exertional Compartment Syndrome

Surgical intervention involves release of the affected lower leg compartments.  A selective fasciotomy (release) is completed on the affected compartments—this is typically dictated by location of symptoms and preoperative pressure tests.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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