Clinical features of chronic exertional compartment syndrome

The pain of chronic exertional compartment syndrome is often described as a tightness or pressure that tends to start at a consistent exercise intensity or duration (eg while running). It worsens with continued activity and eventually leads to cessation of exercise. The pain resolves with rest, often within 10 to 20 minutes.

If a person with suspected chronic exertional compartment syndrome affecting the anterior compartment of the lower leg, presents soon after activity, findings on examination may include:

• firmness or tenderness in the anterior compartment of the leg
• pain with passive toe and ankle motion
• focal swelling associated with herniation of muscle through fascial defects.

Examination may be normal in a person with suspected chronic exertional compartment syndrome affecting the deep posterior compartment of the lower leg, because it is not accessible to palpation; however, in some cases, weak toe flexion may be seen.