Chronic Exertional Compartment Syndrome Turned Acute in a High School Female Cross-Country Athlete

To present the case of a high school female cross-country runner diagnosed with compartment syndrome that needed emergency surgery two weeks after the initial onset of symptoms. An 18-year-old female cross-country runner suffered pain in the lower legs that caused pain with walking the morning after a successful practice. Over the course of a week, the symptoms increased to numbness and tingling during practice and eventually at rest, never subsiding. When the symptoms became too excessive, a trip to the emergency room was required to have emergency double incision bilateral fasciotomies. A fasciotomy is typically required for compartment syndrome because conservative treatments do not work. Chronic exertional compartment syndrome (CECS) allows surgery to be scheduled at a later day, whereas acute compartment syndrome (ACS), surgery is immediate. In this case, surgery was scheduled for a later date but became emergent. CECS may go undiagnosed for months within athletes due to the decrease in symptoms with rest and differences in training intensities and durations. However, clinicians need to be aware that CECS may become ACS with trauma to the lower leg or over time. Understanding the differences in compartment syndromes and knowing CECS can become ACS, allows clinicians to be ready for all scenarios in terms of evaluation and treatment. Differential diagnoses include medial tibial stress syndrome, stress fracture, nerve entrapment syndrome, or popliteal artery entrapment syndrome