Surgery to fix compartment syndrome

I had the surgery back in October. I didn't have to do any rehab or anything like that, but I had to take two weeks completely off and then another two weeks of cross training. I started running two or three miles every few days and then from there I gradually built up my mileage, by december I was around 35-40 mpw and by February I was up to 70. Prior to the surgery I could only run about 2k at anything under 6:00 pace. I thought the surgery would fix it completely but i still experience symptoms when i get to around 3400m-4kish. Sometimes the surgery doesn't take the first time and you have to get it redone, i think this might be the case. For me it was worth it because it allowed me to get at least some decent base and i have had an improvement in times, plus it is my senior track season and i wanted to make the most of it. Weirdly enough my symptoms have never happened when I am running the steeple, so that has been my main focus the past few years.

Hmm, it's good to hear that you didn't have any real issues.

For me, it's always between 20-30 minutes into a run that my calves get to the point where I have to stop running. I usually wait about 10 minutes then continue. It works, but it leaves my muscles feeling tight and I don't run as well in the workout usually. If I'm doing a long run, it always means I have to cut the run short.

I'm not an extreme case though. It always happens during times of intense training or when I'm getting ready to do the real work after my base build up.

That's why I'm having troubles deciding if it's worth it or not.

Have you been tested for exercised iduced compartment syndrome? Now i'm no doctor, but if you did get tested and your pressures were high enough I would think that it would be worth it to get the surgery done. If you haven't been tested i would recommend you go in and get tested so you don't end up having an unnecessary surgery

Yeah, I was going to decide whether or not I wanted to get it done before going for a test, but I think it would be worth going. It might help me figure things out.

I had the surgery and was running again in 10 days. I had no rehab and pretty much jumped right back into training. I had a Cankle for about a year but no pain. I had compartment syndrome really bad once before and just took about 4 months off and let it go away but this time it was much more painful and the muscle was even popping out of my leg (it looked like a hernia) I had the pressure test and it was really high at first but then kind of went down so the doc could not say for sure that is what it was but we went ahead with the surgery anyway and it worked. I have heard that sometimes scar tissue builds up and you have to have it again bur so far I have been good.

Timely question...I just wrote this on another thread a couple of days ago:

I had the test done on my left leg last August and surgery last September. Was up and running again pain-free in about 8 weeks and ran at a higher intensity and volume than I had in three years after about 3 months after the surgery. Then I started to get some issues on my right leg about a month ago, and didn't hesitate to get the test and surgery on my right. I'm fortunate to live fairly close to the US Ski team Orthopedic doctors, so I've got some confidence in their skills, and my personal doctor has a 100% success rate on fatiotomys so far over her 16-year career.

Bottom line is, I went through 3 years of mis-diagnoses before I went to the US Ski team docs, and those have been some of the most miserable years of my life. Now I've had a glimmer of hope I can get back to my old self again. The surgery is really pretty minor, and the ensuing physical therapy has helped me address a lot of other issues that I have.

Call around and find a doctor that regularly performs the surgery and is familiar with the diagnosis and procedure. My doctor never releases only one compartment regardless of the pressure test (she always releases all four), and is very aggressive with physical therapy, and gave me a few journal articles illustrating why she developed those practices. She even recently alerted me to a study (if you can call it that) that correlated running form and compartment syndrome, and noted the merit and draw-backs of the study and how it applies to my pressure tests.

Good luck and happy trails

Some terrible images accompany a search on this. I wish no one had to deal with this. Its just wrong.

A couple additional things to consider...

While I was mis-diagnosed with a ruptured gastroc for three years, I attempted to continue to run and the compartment syndrome gave me irreversible nerve damage in my peroneal nerve.

If you think it's compartment syndrome, it's worth the test, and I'd avoid the Google searches...the surgery really was not too bad, but if you go through the surgery, get yourself a good PT. Most of the PT work was soft tissue mobilization and stability type drills (4-6 weeks). After that they called it "functional physical therapy," which translated into running as much as I can and massage. Can't complain about that treatment.

redux wrote:

Some terrible images accompany a search on this. I wish no one had to deal with this. Its just wrong.

I just did a search and was surprised with the results. Keep in mind technology has advanced and they don't perform surgery that way anymore. They don't cut open the entire leg. They make two small incisions about 1" in length and use a fiber optic cable to go underneath and release the fascia. I've had the surgery done on both legs and you really have to try hard to find the scars.

I seeeeeeee. Well, that's good to know. I still don't want anyone to deal with this. It sounds terrible on every level.

I have also considered this from time to time. I've been injured for almost 8 years now. It started with a stress fracture, then just shin splints and whatnot as I tried to get back to running during the next year. Then I got what the doctor said was probably compartment syndrome, although I never got tested. And since then, for 7 years now, I've had constant calf problems anytime I try to start training. I'm talking like a few weeks of 15-20 miles a week and my calf problems pop up and I have to take time off.

I'm wondering if I should go get tested sometime.

Also, the past year and a half I haven't really been able to run for more than about 20 minutes before my calves get really sore, no matter how long I've taken off before the run (days, weeks, months, whatever).

If just getting the surgery could get me back to running I'd feel pretty silly losing running for basically my entire 20's because I didn't get it.

It's been 100% worth it for me, and I'm generally in the same boat as you. For you and I, the surgery is kinda second to dealing with all the compensatory reactions we've built up while trying to push through the surgery. Just getting my nerves and muscles to fire in the appropriate sequence has been the biggest battle for me. There are also some issues in my ankle from the swelling that still happens from time to time, but compression socks seam to have nipped that in the butt.

For an illustration, I averaged 12 mpw for 2009-2010. I had the first surgery (left leg) in September of 2011 so that year was off. In 2012 (before my right leg started to flare up), I averaged 55 mpw, and even ran a few mile repeats at 6:00 pace. I think My left leg blew up first due to some asymmetry from soccer and high jumping in my youth.

I'm just now starting my most methodical, concerted, and slowest approach yet to get back into running since my calf problems started 7 years ago. I'm gonna focus on flexibility and strengthening stuff all spring and summer while only running 2 to 3 miles at a time. With whatever days off I need if my calves are especially sore after a run. So i'm gonna try this through the summer and into the fall, but if this doesn't work I think over the winter I will have to go get tested for compartment syndrome and think about surgery. I'm really tired of seeing hobbyjoggers just going about their 25 minute jogs and thinking how its been years since I've been physically able to even just do that.

Why put the test off? The test is not comfortable, but you'll recover from it quicker than a major CECS calf cramp. If you CECS, You could potentially be ready for a marathon come fall. You've already suffered through 8 years, why frustrate yourself for another? If you have CECS, there's no other cure.

Thanks a lot guys. I'm really considering getting it checked out now.

Next fall I have a busy schedule in school, so I plan on getting tested this summer and hopefully get the surgery done in conjunction with the term (if it's needed). Had issues on my run again today and I'm getting tired of my training suffering for it.

InWyo wrote:

A couple additional things to consider...

While I was mis-diagnosed with a ruptured gastroc for three years, I attempted to continue to run and the compartment syndrome gave me irreversible nerve damage in my peroneal nerve.

If you think it's compartment syndrome, it's worth the test, and I'd avoid the Google searches...the surgery really was not too bad, but if you go through the surgery, get yourself a good PT. Most of the PT work was soft tissue mobilization and stability type drills (4-6 weeks). After that they called it "functional physical therapy," which translated into running as much as I can and massage. Can't complain about that treatment.

InWyo- What are the symptoms of your nerve damage? I'm still experiencing tightness in the compartments that were affected by CECS and the tightness is then followed with a foot drop. During my postoperation visits when i had started back running the doctor said these reoccuring symptoms were due to nerve damage from having the condition for so long but that it may go away over time. It's been about 4 months with no improvement so i'm thinking that i may need to have the surgery again or that the nerve damage is permanent (hopefully not) or maybe i'm just being impatient. Also, where can i find that journal article that discusses the correlation of running form to CECS?

Just out of curiosity: Any of you use creatine?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421498/

I don't, but for a runner I am a bit of an mesomorph which might have something to do with it.

I coach an athlete right now that recently had the surgery. We tried all kinds of non surgical therapies but nothing really helped. You definitely want to see a top specialist on this one, because the best will know much better about how much fascia to remove. Also, a doc that works on competitive athletes.