Compartment syndrome, commonly known as chronic exertional compartment syndrome (CECS) is an exercise-related condition that results in lower leg pain. CECS differs from acute compartment syndrome, which is a medical emergency that usually occurs after severe injuries or serious infections. In this context, when I say “compartment syndrome,” I am referring specifically to chronic exertional compartment syndrome of the lower leg.
In this article I’ll feature compartment syndrome in runners and how to prevent it.
Causes of Chronic Exertional Compartment Syndrome in Runners
Chronic exertional compartment syndrome (CECS) is almost exclusively attributed to running with heel strike landing, a running style which prompts dramatic rise in lower leg pressure, resulting in chronic lower leg pain.
In heel strike running, there is greater activation of the dorsiflexors which in turn causes the anterior compartment pressure to rise. This also increases anterior- posterior braking forces and vertical ground reaction forces, further exacerbating the rise in compartment pressure of the lower leg during heel running. This results in chronic lower leg pain.
Symptoms of Chronic Exertional Compartment Syndrome
- Lower leg pain which usually goes away during rest.
- Tingling or numbness on the lower leg due insufficient blood in the nerves.
- The affected leg feels very tight.
- The affected leg becomes weak
- In rare cases you might experience muscle hernia which might cause swelling
Usually, lower leg pain can result from other conditions like tendonitis, shin splints and stress fractures. So, your doctor will perform tests to rule out these conditions.
Diagnosis of chronic compartment syndrome is accomplished by comparing the pressure changes within the affected compartment before and after exercise. Normally, the pressure change within the compartment should be very small before and after exercise.
If there’s dramatic increase in pressure after exercise, then the test for chronic compartment syndrome is positive.
Treatment for Chronic Exertional Compartment Syndrome
Treatment for compartment syndrome may be surgical or non-surgical depending on the severity.
- Taking a rest from activity.
- Avoiding restrictive exercises or activity.
- Wearing minimalistic running shoes to encourage forefoot landing.
If the conservative remedies fail to eradicate the symptoms, your doctor may recommend a surgical operation on the affected compartment. The operation aims at opening the fascia to give your muscles more room for swelling.
This should be done by a skilled surgeon to avoid damaging the small nerves associated with the tissue.
Does Forefoot Running Reduce Lower Leg Pain?
Usually, heel strike landing is regarded as the greatest risk for exercise related chronic exertional compartment syndrome (CECS) among runners. It is somewhat a forceful running posture which produces high impact forces between your foot and the ground. This causes an increase in anterior compartment pressure, which in turn leads to lower leg pain.
However, recent studies have shown that, adopting a forefoot running can significantly reduce the risk of suffering CECS. In forefoot running there is less ankle dorsiflexion and higher knee flexion at touchdown, ultimately providing greater comfort for the lower leg. Apparently, the best way to achieve forefoot running is to choose the correct running shoes.
How to Choose Running Shoes for Chronic Compartment Syndrome
Basically, the best running shoes for compartment syndrome are minimalistic running shoes that encourage forefoot striking during running. Minimalistic running shoes are designed to let both the forefoot and the mid-foot hit the ground first.
Here are some important features to look for when looking for the best minimalistic running shoes.
- Less Than 1mm Heel-To-Toe Drop
The most outstanding feature inherent in minimalist running shoes is the less than 1mm heel-to-toe drop. The purpose of this configuration is to force the toes to be at same level with the heel during touch down.
Minimalist running shoes should be flexible enough to allow your feet move and bend naturally without straining. You are therefore able to control your motion and avoid injuries during running.
For an optimal minimalist experience, you need a running shoe that is incredibly light. You should actually feel like you’re running barefoot. It should have less additional obstructions that hinder natural movement of the foot.
Breathability cannot be overlooked in a minimalist running shoe. The material inside the shoe should also allow proper heat dissipation and moisture absorption to reduce foul smell. The overall configuration of this shoe is to give runners maximum comfort during running.
The outsole of minimalist running shoes is made to be as thin as possible for a better ground-feel sensitivity. So, you should look for a shoe that has high quality rubber on the outsole to enhance durability and good traction over the surfaces.
The key to resolving and preventing exercise-related compartment syndrome is to transition from heel strike landing to forefoot running. This can be achieved by running in minimalist shoes that protect your foot from heel striking.
In addition, minimalist running shoes gives you proper ground response so that you don’t hurt your foot during the entire gait cycle.
- Fuller et al. Effects of a minimalist shoe on running economy and 5-km running performance. J Sports Sci, 2016; 34:18, 1740-1745.
- Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. 2000; 32:s4-s10
- Kirby RL, McDermott AG. Anterior tibial compartment pressures during running with rearfoot and forefoot landing styles. Arch Phys Med Rehabil. 1983; 64:296-299