Bilateral Chronic Exertional Compartment Syndrome of the Leg: A Rare but often Debilitating Condition in Athletes.

This report discusses an unusual case of bilateral chronic exertional compartment syndrome (CECS) of the lower leg, a syndrome found mainly in young athletes. Pathophysiology includes exercise-induced muscle expansion against noncompliant fibro-osseous membranes separating compartments of the lower leg. A 24-year-old female distance runner with a history significant for misdiagnosed shin splints and tibial stress fracture presented with acute-on-chronic right lower leg pain. History revealed exertional pain and numbness, alleviated by rest. Subsequent MRI found no tibial abnormalities, and intracompartmental pressure testing demonstrated four compartment pressure elevations, confirming a CESC diagnosis. A minimally-invasive four compartment fasciotomy was performed in the operating room. Two months after return to running, symptoms were improved in the right leg, but appeared in the left leg. Subsequent pressure testing on the left revealed CESC, and four compartment fasciotomy was performed. Her symptoms significantly improved and she returned to running at six weeks without pain bilaterally.