Anterior Compartment Syndrome

[JoelF]

I am a 54 white male, and, for at least 30 years, have experienced lower leg pain (lateral, along the tibia) when walking.  I suspect Anterior Compartment Syndrome because the pain subsides upon rest and orthodics, designed to correct pronation, have not relieved the problem.  Onset of pain is often within 5 minutes of starting to walk at a moderate speed.

However, two things don't seem to fit.  1) The pain is sometimes on the left, sometimes on the right, and sometimes on both legs.  2)  After resting for 5-10 minutes, the pain goes away and does not return; I can walk for miles.

Another clue may be that about 20 years ago I attempted to go cross-country skiing.  After 3 strides I fell over in intense pain: the same pain I experience when walking.

Do these symptoms suggest Anterior Compartment Syndrome or perhaps something more serious, such as PAD?  If the former, are there any measures I can take to alleviate the problem, such as different shoes, etc?

Thanks in advance.

[Yena H Do, DPM]

Perhaps: the swelling had stretched the fascia.  After rest and resumed walking, the muscles swell, but the fasia has been previously stretched out enough to accommodate the swollen muscles, which prevent pain during the second round of walking.

[JoelF]

Thanks.  I understand what you said.  But I do not understand why the pain does not return when I resume walking again after a 5-10 minute rest, during which the initial pain disappears.

[Yena H Do, DPM]

The pain lessons after rest b/c the muscle stops contracting.  When you contract a muscle, it enlarges: which takes up more space in a tight compartment (eg:  when you flex your bicep muscle, your arm looks bigger). In patients with compartment syndrome, the fascia doesn't stretch enough to accommodate the enlargement, thus increasing the "compartment pressure" and causing pain.

[JoelF]

Thank you.  I doubt that I have PAD/PVD, as I have none of the other typical symptoms.  Also, this specific leg pain began while I was in my very early 20s.

What confuses me is why the initial pain would ameliorate on rest (5 minutes) and then not return again when I resume walking.  I assume the most important diagnostic would be the intracompartmental pressure, which I will have scheduled.

Thanks again.

[Yena H Do, DPM]

It sounds like compartment syndrome.  BUT, I would also get vascular studies to see if you have peripheral vascular/arterial disease.  Typically, PAD/PVD causes calf pain after minutes of walking.
You should get an intracompartmental pressure reading to determine if you have compartment syndrome.  The physician would place a WICK's catheter into the shin after you walk and experience pain.  A pressure reading of over 35 would suggest compartment syndrome.  In this case, a surgical procedure called a fasciotomy (release of the compartment fascia) would be very beneficial for you.  Once you are tested negative for PAD or compartment syndrome, I would go to podiatrist who is knowledgeable in performing a gait evaluation and see if there is something that is contributing to you pain.