What is Compartment Syndrome?

Compartment syndrome is found in your lower limbs, within your leg/shin. There are four compartments within your lower leg with the anterior compartment being affected most often. There are two types of compartment syndrome: acute and chronic.

Acute compartment syndrome commonly arises from an injury to the lower leg or shin, such as a tibial fracture or a severe contusion and needs to be repaired surgically.

Chronic Exertional Compartment Syndrome (CECS) consists of pain during activity within your shin while active and is relieved with rest. Although there is no clearly defined pathology, we do know that with CECS, increasing exertion during activity can cause an increase in the intracompartmental pressure within the lower limb. This ultimately results in a feeling of fullness or cramp like symptoms. It is important to note that CECS can only be diagnosed through proper testing. This is commonly done through needle manometry (where a needle is inserted into the skin to measure the pressure within the affected compartment.).

What is Tibialis Anterior Tendinopathy?

This form of tendinopathy affects the tibialis anterior muscle which originates on the upper two-thirds of the tibia (shin bone) and inserts onto two bones located within the inside part of your foot (medial cuneiform and first metatarsal). This muscle is responsible for dorsiflexion (bringing your toes towards you shin), and inversion of the foot. It also plays a role in controlling how fast the forefoot is lowered to the ground. Tibialis anterior tendinopathy is commonly seen in runners and can develop due to overuse and inadequate recovery time between activity.

What do people experience?

A feeling of fullness, pressure, or cramp-like symptoms within your lower leg.
Tingling or burning (paresthesia)
Symptoms worsen with exertion and stop immediately or soon after activity
Over time you may note that symptoms may take longer to subside after activity
Stretching the lower limb musculature may result in pain

Tibialis Anterior Tendinopathy

Pain within the front part of your shin
During the early stages the pain will be present during the warm-up or beginning of activity; during later stages, pain will progress to being present during and after activity has stopped
Gradual onset of pain during prolonged activity
Patients will commonly describe the pain as being dull at rest, but sharp during activity

Risk factors for discomfort include:

Risk factors for compartment syndrome and tibias anterior tendinopathy include:

Hill running (up or downhill)
Increasing activity too soon, too much, or too fast
Forefoot or rearfoot deformities that may not be properly accommodated for
Improper or worn out footwear

What are my options for treatment? Who can help?

If conservative treatment does not seem to be beneficial, visit your family physician and rule out other pathologies that are also commonly found in the lower leg, such as tibial stress fractures, tibial periostitis, or medial tibial stress syndrome. Needle manometry is commonly recommended and will allow the physician to properly diagnose CECS by examining the pressure within the affected compartment.

Staying active with a plan

When suffering from pain due to compartment syndrome, refraining from the activity causing the pain is recommended. This does not mean that you must completely stop all activity, but rather that you must incorporate other forms of physical activity into your routine. Cross-training and other low impact activities, such as swimming or using an elliptical machine, are recommended to limit the pain. Keep in mind that recognizing the signs and symptoms that relate to CECS can be beneficial so symptoms do not become prolonged after activity.

Keeping active with tibias anterior tendinopathy can be achieved multiple ways. It is important to recognize symptoms relating to this issue. If you can decrease or modify the current activity you are performing by decreasing the duration or increasing the amount of rest you allow between sessions, it can allow the muscle time to heal. As mentioned above, cross-training and a change in activities can be beneficial in reducing the pain and relieving the constant stress from the affected tissue

Chronic Exertional Compartment Syndrome (CECS) and Tibialis Anterior Tendinopathy

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How can SoleScience help you feel better?

Locating areas of higher pressure on your foot:

In-shoe pressure sensors (F-Scan)
Pedograph scans (Harris Mat)
Footwear analysis and education
3D foot casting

Gait and movement testing:

Static alignment
Dynamic movement testing
2D clinical gait analysis
3D clinical gait analyses
Arch height index

The pedorthists at SoleScience will work with you to help you feel better immediately following your first visit. While you are waiting for your custom foot orthoses to be manufactured (typically 3 to 5 days), your pedorthist will work with you to improve comfort, both in and out of the house.

Our take on the need for custom foot orthoses

Custom foot orthoses are appropriate for a variety of conditions and compartment syndrome and tibialis anterior tendinopathy are no exception! Depending on your foot type and biomechanics, an off-the-shelf orthotic may work just fine. However, if there are numerous factors such as shock absorbency issues, foot deformities, or abnormal biomechanics contributing to the problem, custom orthotics can be the better option.

A thorough assessment of the foot and lower limb can be highly beneficial when dealing with either of these conditions. Ensuring that there is no forefoot or rearfoot deformity present that is contributing to increased or unwanted motions of your foot can be crucial. Through the use of custom orthotics, we can capture the desired position of your foot to limit, control, or accommodate for the motions of the foot that are contributing to this issue while providing you a level of cushioning and comfort. Finally, the adjustability of the custom orthotic allows us to tailor it to your specific needs and purpose that you use them for.

Custom vs. OTS

OTS, or off-the-shelf orthotics, are pre-fabricated devices that can be fit in to your shoes right from the shelf. This type of orthotic is typically heat moldable, allowing for a degree of immediate customization. Truly custom-made foot orthoses are differentiated in that they are designed specifically around a 3D model of your foot. This type of orthotic can be completely tailored to suit your needs.

Footwear recommendations

Appropriate footwear selection is important for daily comfort and activity. Generally speaking, footwear with ample cushion and the proper support can work well when managing pain related to medial tibial stress syndrome. No matter which shoe you select, proper fit is vital. Length, width, depth, and heel height are important considerations to make. Consult with your pedorthist for recommendations specific to your foot type and intended use.

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