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I have a patient who I suspect has CECS in the medial compartment of the foot. I would like to confirm my diagnosis with intracompartment testing before referring for surgery. Does anyone know of a practitioner who can conduct this in the Brisbane (Qld) region?

Cheers,

Barry Hawes

 

Hi Barry,

Dr Mark Young (sports physician) or Dr Mark Craig (musculoskeletal doctor) both do compartment pressure testing. Mark Young is at Brisbane Orthopaedic and Sports Medicine Centre in Brisbane Private Hospital (ph: 3834 7009) and Mark Craig is Queensland Physical Medicine, Centenary Aquatic Centre (ph: 3839 7600).

Cheers,
Kent

PS - Are you seeing patients at 5:30am on a Saturday morning???

 

Thanks Kent,

We don't have anyone, to my knowledge, providing this service in my region of the Sunshine Coast, and we lost our only sports physician (Dr June Canavan) tragically in a plane crash recently at Kokoda. She was a great source for referral for second opinion for some of the more unusual MSK conditions we sometimes see.

Do you have any experience in the conservative management of CECS in the foot? My experience is limited to 2 previous cases and I can't find much in the literature.

Cheers,

Barry

(not seeing patients, but doing bits and pieces before getting snowed under!)

 

Barry:

Here is a paper that Matthew Mollica wrote 11 years ago which was published in JAPMA.

 

Thanks Kevin,

I have this paper in my files from years ago and have referred to it. It's a nice case study of an unusual condition. Do you (or any others out there) have any personal experience in conservative treatments for CECS in the foot (eg. myofascial release/physio).

Cheers,

Barry Hawes

 

Barry:

I have had some limited success using foot orthoses to reduce the pain associated with this condition. However, the bad ones need surgery. Having done surgery on these, I would tend to doubt anything other than surgery would help them due to the pressure that the muscle is under due to the tight abductor hallucis fascia. In addition, I think that it is possible that this condition of excessive tightness of the abductor hallucis fascia may be responsible for other compression-related nerve injuries in the area.

I have attached a paper that I co-authored from 17 years ago on a power lifter that had lateral plantar neuropathy and that I successfully treated with foot orthoses. The foot orthoses caused his nerve conduction studies to normalize (Johnson ER, Kirby KA, Lieberman JS: Lateral plantar nerve entrapment: Foot pain in a power lifter. Am J Sports Med, 20 (5):619-620, 1992). I think this paper is the only report within the medical literature which shows a normalization of nerve conduction studies due to foot orthosis treatment.

 

Kevin,

Interesting. One of the other cases of CECS I've seen was in the lateral compartment and certainly presented with neural symptoms. She went on to surgery. The current case in the medial compartment includes paraesthesia in the hallux as a secondary symptom.

Many thanks,

Barry