Purpose: Chronic exertional compartment syndrome (CECS) is a disorder commonly seen in athletes and is associated with repetitive exertion. CECS is caused by increased pressure in the fibro-osseus space. This pressure leads to decreased tissue perfusion and ischemic pain. The lower leg is composed of four compartments: anterior, lateral, deep posterior, and superficial posterior. CECS most commonly occurs in the anterior compartment. This video reviews the important structures in each of the four compartments of the lower leg. CECS often is refractory to nonsurgical management unless the inciting activity is completely ceased. This video describes the diagnosis and workup of patients with CECS and demonstrates the surgical technique of fasciotomy used to manage CECS.

Methods: The video discusses the case presentation of three patients. The first patient is a 19-year-old female soccer player who has experienced bilateral calf pain for 1.5 years. Her pain is exacerbated by exercise and relieved with rest. Compartment recordings showed elevated pressures at baseline without elevation postexercise. The second patient is a 28-year-old man with worsening leg pain on ambulation. His pain is present at rest and with exercise. Compartment recordings showed elevated pressures at 1 minute and 15 minutes postexercise. The third patient is a 21-year-old man who complains of muscle hernias, which are a potential sequela of compartment syndrome. The muscle hernias are herniations of muscle through fascial defects. He reports progressively worse leg pain on ambulation and has a history of two right lower extremity hernias of the peroneus longus tendon. In all three patients, four compartment fasciotomies were performed.

Results: Excellent clinical results have been reported in the literature and were reported in the three patients discussed in this video. Physical therapy is initiated 2 weeks postoperatively, and return to sports is possible at 6 weeks postoperatively.

Conclusion: CECS is an uncommon but often unrecognized source of chronic extremity pain in athletic patients. A careful patient history and physical examination in combination with appropriate diagnostic tests are necessary to correctly diagnose CECS. Nonsurgical treatment rarely is effective in patietns with CECS unless the inciting activity is completely ceased. Surgical fasciotomy leads to good results and return to function.