Anterior compartment syndrome

Findings

The anterior compartment is often bulky, looking muscle bound, and, when the symptoms are acute, there may be tenderness to palpation. The diagnosis can frequently be established in the consulting room by making the patient repeat rapid dorsiflexion movements of the feet whils lying on the couch.

Cause

The tibialis anterior, extensor hallucis and extensor digitorum longus muscles are involved. Some people walk, or march, with their toes and foot pulled upwards, and this overworks the anterior compartment muscles. Shorter soldiers, who have to maintain the same long stride length as their taller companions, are prone to this condition. Others have had pronated feet for a long time and have adapted to the problem by internally rotating the foot, and then using the dorsiflexors of the foot to prop up the arch and stabilize the first ray. Those with anterior compartment problems counteract overpronation by overworking the tibialis anterior muscle.

Treatment

Orthotics, core stability and reduction in loads and/or surgical fascial split of the anterior steath.

Sports

a)      Running – the shuffle type of runner will often have worn a hole in the top of the shoe, from the big toe pulling into dorsiflexion and rubbing into the shoe.

b)      Untrained cross-country skiers, from pulling the ski forwards with the foot.

c)      Sit-up exercises, undertaken with the toes wedged under a bar to keep the feet down and provide leverage.

d)     Marching – possibly from smaller individuals having to stride out, with their feet emphasizing dorsiflexion, as part of a marching style. To overcome this problem, the armed forces have stopped sorting platoons by size, with the smallest in the middle

Comment

Correction of the cause is often successful, but a fascial split returns the athlete to sport rapidly. The compartment test exercise should copy the individual’s exercise pattern. The history of exercise-induced pain is an important diagnostic indicator.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English