You’ve probably had leg pain at some point. Maybe you overdid it exercising, spent a long time on your feet or bruised your thigh or calf. Usually, that type of pain isn’t a sign of an emergency. The pain goes away once you recover.
But in some cases, especially after trauma or surgery, persistent leg pain could signal a more serious problem called compartment syndrome. This condition affects your muscles and nerves. If you don’t treat it, you can have long-lasting damage.
Joseph (Brock) Walker, MD, an orthopedic surgeon with Banner - University Medicine, explained more about what compartment syndrome is, the symptoms to look out for and when to see a health care provider.
What is compartment syndrome?
“Compartment syndrome is a rare but dangerous condition that can occur after trauma or surgery. It is most common in the lower leg and the forearm,” Dr. Walker said.
Your arms and legs are divided into sections called compartments that contain muscles, blood vessels and nerves. These compartments are surrounded by tough tissue called fascia that’s similar to plastic wrap.
“The fascia layer does not have much give to it. If the muscle swells too much, the pressure in the limb starts to rise. Compartment syndrome happens when pressure builds up inside one of these compartments,” Dr. Walker said.
The pressure can reduce blood flow, which causes pain and damages muscles and nerves.
There are two main types of compartment syndrome:
Acute compartment syndrome
Acute compartment syndrome is a medical emergency. It usually happens after a serious injury or surgery.
Chronic compartment syndrome
Chronic compartment syndrome, also called exertional compartment syndrome, develops over time. It is usually caused by exercise or repetitive activity. “The swelling and pain typically stop shortly after you stop exercising,” Dr. Walker said.
Chronic compartment syndrome is most common in:
- Runners and cyclists
- Athletes who do high-impact sports
- People who suddenly increase the intensity or length of their workouts
What causes compartment syndrome?
Acute compartment syndrome is often caused by:
- A broken bone
- A severe bruise or crush injury
- A tight bandage or cast
- Surgery or bleeding inside a muscle
“Acute compartment syndrome is usually associated with severe injuries like motorcycle accidents or falls from height. But it can sometimes happen after less severe injuries or relatively simple surgeries,” Dr. Walker said.
It can also occur due to:
- Bleeding in a limb
- Inflammation in a limb after blood vessel repair surgery
- Poor positioning of a limb during surgery, even a limb that’s not being operated on
Warning signs should you watch for
Lots of different things can cause leg pain. Symptoms of compartment syndrome include:
- Aching, burning or cramping pain in the lower leg
- Pain that starts during exercise and gets worse over time
- Numbness or tingling
- Leg swelling or tightness
- Difficulty moving your foot or toes
- In severe cases, pale or shiny skin
If you notice any of these symptoms, especially if the pain is severe or doesn’t improve with rest, see a health care provider right away.
Why is compartment syndrome a medical emergency?
Acute compartment syndrome can get worse quickly. The pressure blocks blood flow. “If the pressure rises too high, blood cannot flow into the muscle and the muscle and nerves in the limb can die,” Dr. Walker said.
This can lead to:
- Permanent muscle weakness
- Nerve damage
- Loss of function
- Infection
- In rare cases, amputation
- Kidney damage, if there’s a lot of muscle death
That’s why it's important to treat acute compartment syndrome as soon as possible.
How is compartment syndrome diagnosed?
Your provider will ask about your symptoms and perform a physical exam. “The hallmark features of compartment syndrome are ‘pain out of proportion’ and ‘pain with passive stretch,’” Dr Walker said.
Pain out of proportion
“Pain out of proportion is hard to define, because some pain is expected after trauma or surgery and everyone’s pain tolerance is different,” Dr. Walker said.
People who are in extreme pain that lasts even with pain medications and changing their position should seek evaluation.
“If just bumping the bed or any vibration causes severe discomfort, you should be checked,” Dr. Walker said.
Pain with passive stretch
Pain with passive stretch is extreme pain when muscles are moved by someone else. In the leg, you would have extreme lower leg pain if someone else gently moved your toes or ankle up and down.
Sometimes, it’s hard to get a diagnosis. It can be difficult in people with a high pain tolerance or those who are intubated or sedated. In cases like those, a provider can insert a needle into the muscle to get a pressure reading.
A provider may also order imaging tests to rule out other causes of pain.
Acute compartment syndrome can become dangerous quickly. So if your provider thinks it’s likely, they may go straight to treatment to help prevent complications.
How is compartment syndrome treated?
Treatment for compartment syndrome depends on which type you have.
Treatment for acute cases
Treatment usually involves emergency surgery called a fasciotomy. In this procedure, a surgeon makes small cuts in the skin and fascia.
“Opening these layers gives the muscle room to swell, decreases the pressure in the leg and allows blood flow to continue to the muscles,” Dr. Walker said.
Treatment for chronic cases
Treatment may include:
- Taking a break from high-impact activity
- Physical therapy to improve flexibility and muscle balance
- Anti-inflammatory medication
- Custom orthotics or shoe adjustments
- Surgery in some cases, if symptoms don’t improve
Can you prevent compartment syndrome?
You can’t always prevent compartment syndrome, but there are steps that may lower your risk.
For chronic compartment syndrome, it can help to:
- Gradually increase your activity level
- Avoid pushing through pain
- Stretch before and after exercise
- Wear properly fitted shoes
- Switch up your routine to avoid overusing the same muscles
- Talk to your provider before making major changes to your workout, if you’ve had symptoms in the past
Since acute compartment syndrome happens after trauma or surgery, it can’t be prevented. “Early diagnosis and treatment are important for preventing long-term complications,” Dr. Walker said.
When should you see a doctor?
Don’t ignore leg pain that doesn’t go away. Get care quickly if:
- Your pain is severe or getting worse
- You have tingling or loss of feeling in your leg
- You recently had an injury or surgery
- You have swelling or tightness in the leg
Early treatment can protect your muscles and nerves so they’re less likely to be permanently damaged.
How Banner Health can help
Leg pain that doesn’t go away could be serious. At Banner Health, our orthopedic and sports medicine specialists are trained to diagnose and treat conditions like compartment syndrome. We offer:
- On-site imaging and diagnostics
- Personalized treatment plans
- Physical therapy and rehab
- Surgery, if needed
Our team will work with you to find out what’s causing your leg pain and help you get back to doing the things you enjoy. If you think you may be dealing with compartment syndrome, or you want to rule it out, schedule a visit with a Banner Health specialist today.
