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63 SURGICAL CONSIDERATIONS

IN THE LEG

Gregory G Dammann, MD

Keith S Albertson, MD

INTRODUCTION

• As the number of recreational athletes involved in
  running and jumping sports has increased, so has the
  number of patients presenting with exertional lower
  leg pain. Three diagnoses in the differential diagnosis
  of exertional leg pain that may require surgical inter-
  vention are: exertional compartment syndrome, tibial
  stress fracture, and posterior tibial tendonitis.

EXERTIONAL COMPARTMENT

SYNDROME

•Exertional compartment syndrome is activity related

pain caused by an increased intermuscular pressure

within an anatomic compartment. In the leg there are

four compartments that contain muscle, blood vessel,

and nerves. The compartments are enclosed by fascia,

which if tight or thickened will not allow the muscle

to expand during activity and thus cause compression

of all the components of the compartment. The pain of

exertional compartment syndrome is most likely

caused by ischemia due to decreased blood flow in

muscle arterioles.

• Knowledge of the anatomy of the lower leg is vital to
  the diagnosis of exertional compartment syndrome.
  
  
  • The anterior compartment contains the extensor hal-
    lucis longus, extensor digitorum longus, peroneus
    tertius, and tibialis anterior as well as the deep per-
    oneal nerve.
    •The lateral compartment contains the peroneus
    longus and brevis as well as the superficial peroneal
    nerve.
  
  
  • The superficial posterior compartment contains the
    gastrocnemius and soleus muscles and the sural nerve.
  
  
  • The deep posterior compartment contains the flexor
    hallucis longus, flexor digitorum longus, and posterior
    tibialis muscle as well as the posterior tibial nerve.