Compartment Syndrome
(Chronic & Acute)
at Foot Foundation
Compartment syndrome is a painful and often complex lower leg condition that requires accurate diagnosis and timely treatment. Whether caused by overuse during sport or triggered by trauma, it can seriously limit mobility and performance if left unmanaged.
At Foot Foundation, we specialise in recognising the difference between acute emergencies and chronic exercise-related cases, ensuring patients receive the right pathway of care. Our focus is on correcting underlying biomechanics, optimising footwear, and supporting rehabilitation, with direct referral to orthopaedics when needed.
What is Compartment Syndrome?
The lower leg is divided into muscle compartments (anterior, lateral, superficial posterior, deep posterior) enclosed by inelastic fascia. When pressure inside a compartment rises faster than it can be dissipated, blood flow and nerve function are compromised, causing pain, tightness, and sometimes numbness or weakness.
There are two clinically different entities:
Acute Compartment Syndrome (ACS): a surgical emergency usually after trauma, fracture, crush injury, or reperfusion. It causes severe, escalating pain out of proportion, tense swelling, neurologic changes, and can lead to permanent muscle/nerve damage without urgent fasciotomy.
Chronic Exertional Compartment Syndrome (CECS): exercise-induced, reversible pressure rise that settles with rest. Pain and tightness typically begin at a predictable time or distance into running or activity and resolve minutes after stopping. CECS most often affects the anterior and lateral compartments in runners and field/court athletes, but any compartment can be involved.
At Foot Foundation we specialise in recognising CECS, ruling out mimicking conditions, and delivering conservative care (biomechanics, load, footwear, orthoses, and rehab). We coordinate compartment pressure testing and orthopaedic referral when indicated.
Causes & Risk Factors
Repetitive high-load activity: distance running, speed work, cutting/pivoting sports, marching.
Biomechanics: overstride, low cadence, heavy heel strike, limited ankle dorsiflexion, excessive pronation or cavus feet increasing compartment load.
Rapid training changes: sudden increases in volume, intensity, hills or surface hardness.
Equipment: stiff boots (e.g., work or military), worn footwear, inappropriate spikes/cleats.
Muscle hypertrophy or tight fascia: increased muscle volume inside a noncompliant compartment.
Previous leg injuries: scarred fascia, prior fractures.
Anatomical variation: accessory muscles, vascular anomalies (less common).
Treatment at Foot Foundation
(CECS Focus)
Load & Training Modification
Phase-based reduction of provocative loads (tempo, hills, speed) with graded return-to-run.
Surface changes (avoid cambered/very hard surfaces initially).
Structured interval progression to increase tolerance without pressure spikes.
Gait Retraining
Increase cadence (e.g., +5–10%) to reduce overstride and braking forces.
Adjust strike pattern and trunk/hip mechanics to lower anterior compartment demand.
Cueing for softer landing, improved posture, and hip-knee alignment.
Footwear & Equipment
Transition to appropriately cushioned, stable footwear; replace worn midsoles.
Consider slightly stiffer forefoot shoes or carbon plates in selected cases to decrease metatarsal/anterior workload.
Review boots/spikes and lacing to reduce dorsal compression.
Orthoses
Custom foot orthotics to optimise tibial rotation and pronation timing, reduce pathological loads, and offload symptomatic compartments.
Manual Therapy & Mobility
Soft-tissue techniques, myofascial release; ankle/ subtalar mobilisation to improve dorsiflexion where limited.
Calf complex and anterior/lateral compartment stretching as tolerated.
Strength & Conditioning
Progressive calf-soleus complex endurance, tibialis posterior/peroneals control, and hip stabiliser strength.
Neuromuscular drills (balance, proprioception) to improve load distribution.
Adjuncts
Shockwave therapy is not a primary treatment for CECS (it targets tendinopathy), but may assist coexisting soft-tissue pain.
Activity-specific taping or sleeves for symptom modulation.
Referral & Surgical Pathway
If symptoms are refractory after a comprehensive 8–12 week program, or pressure testing is clearly positive with disability, we coordinate orthopaedic referral for fasciotomy.
Post-op, we deliver return-to-run protocols, footwear/orthotic optimisation, scar management, and reload planning.
Symptoms
CECS (exercise-induced):
Aching, pressure, or cramping that starts at a predictable point in activity and settles with rest.
Tight, full, or “bursting” sensation in a specific compartment.
Paresthesia (pins and needles) or numbness in the foot (deep peroneal or superficial peroneal nerve distribution common).
Weakness or foot drop late in an effort (anterior compartment).
Symptoms recur reliably on return to the same load.
ACS (emergency):
Severe, escalating pain (often out of proportion), pain with passive stretch, tense swollen compartment, sensory changes, possible motor deficit. Requires immediate ED review.
Diagnosis
At Foot Foundation, diagnosis includes:
Medial Tibial Stress Syndrome (shin splints)
Stress fracture of tibia/fibula
Tendinopathies (tibialis anterior/posterior, peroneals, Achilles)
Nerve entrapment (common/deep peroneal, tarsal tunnel)
Vascular causes (popliteal artery entrapment, endofibrosis)
Exertional cramps, DOMS, or simple muscle strain
Compartment Syndrome – FAQs
Acute follows trauma and is an emergency requiring immediate surgery. Chronic (CECS) occurs with exercise, resolves at rest, and is treated initially with biomechanics, training changes, and footwear/orthotics.
Pain/tightness begins at a predictable distance or time, compartments feel “full,” and symptoms settle within minutes of stopping. Numbness or weakness may appear late in an effort.
Not always. Many cases can be diagnosed clinically and managed conservatively. Intracompartmental pressure testing is used when the diagnosis is uncertain or before considering surgery.
Yes, in many athletes. Gait retraining, cadence increase, load modification, footwear changes, and orthoses often reduce symptoms to a manageable or resolved level.
Shoes with adequate cushioning and stability, matched to your mechanics. Avoid worn-out midsoles. Specific choices depend on which compartment is symptomatic and your gait pattern.
They often help by optimising foot mechanics and tibial loading, reducing repetitive strain that contributes to compartment pressure rises.
Usually you’ll need a temporary reduction and a structured graded return while we change mechanics and load. Continuing unchanged increases the risk of persistent symptoms.
If a full program does not control symptoms and pressure testing is positive, fasciotomy is the definitive option. Most athletes return to sport after staged rehabilitation.
Protocols vary, but expect walking in days–weeks, light jogging by 4–6 weeks, and progressive return to sport over 8–12+ weeks, guided by pain, swelling, and wound healing.
After trauma with severe escalating pain, tense swelling, pain on passive stretch, numbness/weakness, or pain not relieved by medication. These are red flags for ACS.
Why Choose Foot Foundation?
Foot Foundation delivers specialist evaluation for CECS, including gait analysis, footwear and orthotic expertise, and a structured return-to-run framework. We coordinate pressure testing and surgical referral when appropriate and provide comprehensive post-operative rehab to maximise outcomes.
Care is available at Rosedale, Takapuna, Remuera, Botany, Hamilton, and Tauranga.
