Effort-related chronic compartment syndrome of the lower extremity

Effort-related chronic compartment syndrome (ERCCS) of the lower extremity is often misdiagnosed, requiring repeated visits to the physician and subse quent delay in definitive treatment. The most significant-causes of chronic leg pain in physically active individuals are stress fractures, shin splin ts, and "exercise-induced" or effort-related chronic compartment syndrome. In patients susceptible to ERCCS, the fascial compartments are too small to accommodate the associated 20% increase in muscle mass that typically occu rs with heavy exercise. The increased pressure within a small unyielding co mpartment limits circulation and subsequent muscle function. The only appro priate conservative treatment is cessation of the offending activity. Early suspicion of the condition is paramount, because;the definitive treatment is fasciotomy. ERCCS has only recently been recognized, and therefore it ma y be underdiagnosed, Family physicians and general medical officers caring for otherwise healthy soldiers and athletes should be aware of ERCCS so tha t prompt orthopedic referral for evaluation and definitive treatment will n ot be delayed.