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Have you diagnosed chronic exertional compartment syndrome in a patient's plantar region? If so, what muscles were affected and why did you suspect CECS (also what were the symptoms of the patient)? How did you eventually diagnose the condition?

Some literature claims that symptoms can be procured by palpating the compartment under suspicion but I remain skeptical. Your thoughts?

 

I've maybe had 3 or 4 of these over the years. High index of clinical suspicion every time purely from the history. If it looks and smells like a CECS then it is until proven otherwise in my opinion. I've referred every single one on for further work up/investigation.

See attached for interest.

 

Highly informative paper. I recommend other viewers to read.

Thank you for your contribution. I've been reading up on this due to a patient presenting atypically with a long history, please see: http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=100145

What was your next step after suspicion and early diagnosis? If pain is presenting like with my patient, ICP measurements of calcaneal/medial compartment?

 

Replying again as I edited my other answer with a question (in case you had read my previous answer already without the now included question).

 

There was no next step. Clinical suspicion --> onward referral. These patients don't usually come back (as there is not an awful lot I can do for them) so the steps end there.

Just glanced over your patient findings. Doesn't sound like a CECS to me to be honest.

 

Seems to fit the symptoms, though. Bilateral pain with increasing activity which subsides quickly upon resting. Patient describes the pain as a dull ache which gets increasingly worse which would be consistent with mild ischemia from CECS. The main reason for the suspicion is by exclusion. There is no tenderness upon palpation and all findings are normal. Plantar Fasciitis has been tried extensively and the only treatment left for the patient is surgery.

Can you tell me what it is that makes you doubt CECS for the patient so I can re-evaluate? Thank you.

 

You originally said the symptoms subside when the patient starts walking - therefore difficult to classify it as an exertional pain surely? In my experience of compartment syndrome (minimal with the foot, but a lot with the leg) the pain has rarely, if ever, been described as a dull ache...

 

It starts a dull ache but becomes increasingly bad. Within minutes it's full-blown pain and patient has severe problems standing.

Symptoms do subside when walking, initially, but if walking long distances, patient experiences the same ache and pain. I'm not very familiar with CECS in the foot so I thought that it could be a symptom because of the different mechanics of walking and standing.

How did your patients describe their pain? Were their symptoms worse when walking than when standing?

Would you agree with the poster in my previous thread or do you have a different idea of a diagnosis if not CECS for my patient? Appointment coming up and I don't want to disappoint.

 

The problem here, and with online diagnosis in general, is we have nowhere near enough information (and that information appears to keep changing). It seems from your posts here and in the other thread that standing is what your patient finds most provocative. I personally have never known of a case of CECS where this was the case.

The pain you describe both here and in the other thread is not suggestive to me of ischaemic pain.

In my opinion, and with the limited information given, this does not sound like a CECS. They are usually pretty textbook in their presentations.

The way for all of us to not disappoint our patients is to refer them on if we are not sure what we are dealing with or don't think we can be of any help. I do it all the time!