Current Concepts In Treating Chronic Exertional Compartment Syndrome

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A Historical Perspective On The Emergence Of Chronic Exertional Compartment Syndrome

In regard to chronic exertional compartment syndrome, Voght and Severin originally referred to the condition as march gangrene in 1943.1 They noted that march gangrene occurred in fit young soldiers who were undergoing training.

   Cerumen and colleagues described the condition again in 1944.2 They discussed the assumption that the condition was due to the cumulative affects of multiple microtrauma rather than a single injury. These authors noted the condition “ … stimulated a march fracture and could be called march myositis. This in fact was a misnomer since the pathology was not that of inflammation of muscle but of infarction.”2

   Physicians reported diagnosing the condition in the lower extremities, most often the anterior tibial compartment, with signs and symptoms of pain, swelling and local heat. When physicians utilized electronic diagnostic testing, the muscle showed no symptoms. There was often evidence of peripheral nerve injury and an inability for the patient to move her digits. Patients have also experienced numbness in the first interdigital space of the foot.

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Author(s): 
Robert J. Duggan, DPM, FACFAS

   When performing this procedure, the surgeon must pay special attention to the superficial peroneal nerve because of the risk for muscle injury and excessive bleeding. Post-op management of the patient and wound is similar to any other type of open fasciotomy and one must monitor the patient’s gradual return back to activity as well as local healing of the leg wound and the patient’s general health.

   Dr. Duggan is an Attending Physician with the Florida Hospital East Orlando Residency Training Program in Orlando, Fla. He is a Fellow of the American College of Foot and Ankle Surgeons.

   For further reading, see “How To Diagnose And Treat Chronic Exertional Compartment Syndrome” in the June 2009 issue of Podiatry Today, “How To Test And Treat Exertional Compartment Syndrome” in the May 2002 issue or “How To Detect And Treat Chronic Compartment Syndrome” in the December 2002 issue.




References:


1. Vogt PR. Ischemic muscular necrosis following marching. Presented to the Oregon State Medical Society, Sept. 4, 1943.
2. Sirbu AB, Murphy MJ, White AS. Soft tissue complications of fractures of the leg. Cal West Med 1944; 60(2):53-56.
3. Pandhiar N, Allen M, King J. Chronic exertional compartment syndrome of the foot. Sports Med Arthroscopy Rev 2009; 17(3):198-202.
4. Uzel AP, Lebreton G, Socrier ML. Delay in diagnosis of acute on chronic exertional compartment syndrome of the leg. Chir Organi Mov 2009 Dec; 93(3):179-82.
5. Blandy J, Fuller R. March gangrene. J Bone Joint Surg 1957; 39(4):679-93.
6. Wittstein J, Moorman CT 3rd, Levin LS. Endoscopic compartment release for chronic exertional compartment syndrome: surgical technique and results. Am J Sports Med 2010; 38(8):1661-6.
7. Stein DA, Sennett BJ. One-portal endoscopically assisted fasciotomy for exertional compartment syndrome. Arthroscopy 2005; 21(1):108-112.
8. Fronek J, Mubarak SJ, Hargens AR, et al. Management of chronic exertional anterior compartment syndrome of the lower extremity. Clin Orthop 1987; 220:217-227.
9. Micheli LJ, Solomon R, Solomon J, et al. Surgical treatment for chronic lower-leg compartment syndrome in young female athletes. Am J Sports Med 1999; 27(2):197-201
10. Howard JL, Mohtadi NG, Wiley JP. Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin J Sports Med 2000; 10(3):176-184.









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