Chronic Exertional Compartment Syndrome (CECS) is an unusual cause of pain in the legs during physical activity. It is caused by too much swelling of the muscles in the leg during exercise. This causes a decrease in blood flow to the muscles, resulting in pain and sometimes numbness and weakness of the leg.
Patients with CECS notice a dull ache in the leg with activity. If ignored, the pain becomes so bad that the activity must be stopped. The pain begins at the same time during activity. The pain usually goes away with rest, but it takes some time. It is often easy for someone with this problem to point to the exact location where the pain is.
Sometimes there is numbness, cramping, or weakness in the leg. On rare occasions, the condition will cause shrinking of the muscles in the affected area.
Your foot and ankle orthopaedic surgeon will confirm the diagnosis by measuring the pressure in your leg with a special device while you perform physical activity.
Non-surgical treatment options include stretching, changing your activity level, and sometimes giving up the activities that cause CECS.
If these options don't work or are unacceptable, surgery may be the best way of dealing with the issue. The surgery of choice is called a compartment release. Your foot and ankle orthopaedic surgeon makes one large or two small incisions in the outer tissue of the muscle compartment so that it will decompress the muscle covering called fascia. This decompression relieves pressure and increases blood flow to the muscle. The skin is then closed over the muscle. Sometimes a small camera is used during surgery, which allows for smaller cuts to be made on the skin.
After surgery, the leg is kept elevated for 3-5 days to limit pain and swelling. Knee and ankle joint motion is allowed immediately, as is walking and light activities. You can restart normal activities four weeks after surgery.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Other problems include injuries to the leg’s blood vessels or muscle nerves. Some patients may lose strength in the leg after the tissue covering the muscle is opened.
Most patients are able to return to the activities that the CECS was preventing them from doing.
Generally, CECS does not come back after surgery.
If the symptoms continue over time, your muscles may shrink in size. However, if surgery is done, the muscles typically rebuild in size after the compartment release. This issue rarely leads to long-term injury or damage.
Original article by Sourendra Raut, MD
Contributors/Reviewers: David Garras, MD; Jessica Kohring, MD
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