SYMPTOMS There is a gradual onset of diffuse exercise-induced pain on the anterior lateral aspect of the lower leg. It is common in fairly short but muscular 'bulky' athletes. The pain becomes so great that continued sport is not possible. The athletes complain that the muscles feel like they are bursting. Rest, with the legs elevated, usually relieves the symptoms within minutes.
AETIOLOGY There is an increased intra-muscular pressure within the peroneus and tibialis anterior muscle bulks causing ischaemic pain. This can be due to increased muscle volume from intensive strength training but the true aetiology is unclear. The condition is often bilateral.
CLINICAL FINDINGS There is intense tenderness on palpation over a very firm muscle bulk. The typical pain and swelling can be provoked by repetitive ankle dorsi-flexions against resistance. INVESTIGATIONS Ultrasound or MRIis normal. Intra-muscular pressure measurements during exercise can be made but are not necessary for the diagnosis.
TREATMENT This condition may respond to conservative treatment including modification of training and stretching exercises (stretching of the ankle-calf-hamstrings-quadriceps-hip muscle complex) that can be tried over three months. If this regime is not successful surgery may be necessary to release the fascia (fasciotomy). Surgery is followed by a few weeks of rehabilitation before resuming sport. Weight bearing is usually allowed a few days after surgery. REFERRALS Refer to orthopaedic surgeon for consideration of surgery. Refer to physiotherapist for planning of a few weeks' return programme back to full sport.
EXERCISE PRESCRIPTION Cycling and swimming (when wound is healed) are good alternatives to keep up general fitness. EVALUATION OF TREATMENT OUTCOMES
Monitor clinical symptoms and signs. The symptoms are usually completely gone after surgery. Note that the muscle bulk will be more prominent than the other side after fasciotomy.
DIFFERENTIAL DIAGNOSES Muscle rupture (sudden onset on one leg, localised pain, ultrasound will differentiate), DVT (developing after long-haul flights or surgery, pain and swelling of the entire leg, resting pain).
PROGNOSIS Excellent-Good but if not treated properly it may be the end of the career of an elite athlete.
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