Dr. Braver and Associates specialize in performing exertional compartment syndrome testing as well as treatment for this condition by way of a leg fasciotomy. Dr. Braver has lectured at conferences and authored several publications including a chapter in a podiatric surgical book. He is considered an expert in diagnosing and treating this condition.
Chronic exertional compartment syndrome may be genetic or acquired when one's muscles enlarge through strengthening and/or exercise activity without the ability for the surrounding fascia cover to adequately expand. Furthermore, muscles engorge with blood and fluid during activities and when the fascia does not adequately expand, the muscles get compressed and feel extremely tight and painful. The blood and fluid within the tight muscular compartment, causes pressure against the nerves, often causing numbness or burning and sometimes tingling. In extreme case, it may be difficult to lift the foot upwards.
Exertional compartment syndrome is differentiated from shin splints and stress fractures in that the pains typically occur during activity and resolve soon after rest. Shin splint pain tends to linger after one stops their activities. Stress fractures are consistently painful even when walking.
Exertional compartment syndrome is diagnosed by in office testing utilizing a quick pressure monitor. A drop of saline water is injected into the leg muscle within its’ compartment and a base line pressure is recorded. We then have the athlete run until their symptoms return and the measurement is repeated. The test is then repeated once more after waiting 5 minutes, at which time the pressure should be back to normal.
Dr. Braver and Associates have seen many patients get temporary relief from other treatments including steroid and/or Botox injections. In our experience however, permanent relief is only obtained by fasciotomy. Dr. Braver utilizes various techniques that are well described in several of his on-line videos and published articles. His typical incision is approximately 4 inches centered on the side of the affected leg; the fasciotomy performed subcutaneously. Dr. Braver spends the time in this surgery to examine the nerves within the muscle compartments to make sure scar tissue and entrapment are not contributing to the pain. Dr. Braver has performed many second surgeries of other doctors and has found undetected nerve problems. As a result, Dr. Braver may use a special nonadherent nerve wrap to allow for early range of motion.
Typically, after having performed a fasciotomy, patients are placed in a pneumatic cast boot and instructed to perform early foot and ankle range of motion exercises. There is immediate partial weightbearing with crutches. Full weightbearing is typically around 10 days. If you are coming from out of state for this procedure, please contact our office for hotel and other travel arrangements.
Also, please see Dr Braver’s published article here for more detailed information regarding Chronic Exertional Compartment Syndrome.
Written by Richard T. Braver, DPM, FACFAS