I am a competitive athlete getting ready for the Hawaii iron man event next month. Unfortunately, I have come up lame with compartment syndrome of both legs. I had surgery to release the pressure but now I have an inflamed nerve. Will this get better? What is the treatment for it?


Compartment syndrome describes a condition in which fluid (swelling or blood) builds up inside one or more of the individual compartments of the leg. The “compartments” are easier to understand if you think of each group of muscles and tendons as being surrounded by a protective sheath or lining of connective tissue called fascia. There are individual compartments on the front, sides, and back of the lower leg.

In each compartment, the fascia fits closely to the outer layer of the soft tissue it surrounds — like a sleeve or envelope. The structures are lubricated with a glistening fluid that allows everything to slide and glide against each other. There isn’t a lot of give or room for increased volume of fluid from swelling.

When an injury occurs that leads to swelling, the increased pressure inside the sleeve or envelope cuts off blood supply to the muscles. The muscle cells start to necrose or die. Left untreated, this necrosis can progress to the point of gangrene. Years ago, this problem was labeled “march gangrene” when it occurred in soldiers.

Treatment can be successful with a conservative approach including rest, activity modification, and antiinflammatory medications. But more often, surgery (fasciotomy) to cut the surrounding fascia and release the constrictive soft tissues is required. Even with surgical decompression, complete recovery doesn’t always happen.

Patients with compartment syndrome of the lower leg do face the possibility of symptoms coming back after treatment, complications from surgery, and the need for a second operation. Long-term results can even include an inability to return to full participation in previous activities.

Other soft tissue structures inside the compartment such as nerves can get pinched or compressed. The effect is like a crush injury with damage to the nerves resulting in neuritis, which may be what has happened to you. Treatment is with conservative measures such as physical therapy and medications. All of these effects (including the neuritis) can be transient (temporary) or irreversible (permanent).