Diagnosed with Compartment Syndrome - tests came back negative!

[pinkpussycat]

I will keep this brief as it's a long story!

4/5 years ago was fitted with NHS orthotics as they diagnosed me with flat feet - used to get a lot of shin pain and 'going over' on my ankle.

After orthotics still had the shin pain and started to get pain on the inside of both knees - went back over about 2 years to get different pairs of orthotics. Ended up with about 6 different pairs. Stayed with a pair that made me feel more stable in my ankles - only wear at the moment with my trainers (although these are motion control trainers, which technically if the orthotics did their job properly should I not have neutral ones?) and hiking boots as they don't fit easily in any other shoes. When I tried wearing them all the time, it made no difference to any of my symptoms.

Tried various things as I then started to get really really tight calves on exercising as well as the shin pain and inner knee pain - went to see a chiropractor as I also have upper back problems (but got hypermobility, so I think this is the reason for this). Then was referred for physio on the NHS, she went through various things - thought it was the way I walked, thought I need to strengthen my calves (at this point I was doing moderate exercise, so I don't think I need to strenghten them anymore!). I just felt like she was trying everthing. Then was referred to a consultant physio - she just worked on my 'flat feet', which it turns out it's actually my ankle joint that collapses in, as I have actually got an arch. I did various things with her - she tried strapping my ankles in the right place, had loads of exercises to do which were aimed at training myself not to roll my fee in and collapse my ankles.

So, after numerous visits to the phyio I was starting to despair. I have also developed an unusually large tibial muscle at the front of each leg - which when I show people - they are shocked! This only appears when I flex my foot up.

So, then this year I was referred to the orthopaedic dept at the hospital in Preston, Lancashire. They sent my for an MRI and apparently there is pressure in the gastronemius muscle (spelt right?) so they diagnosed what they thought was compartment syndrome. Was sent for the pressure tests - had these done twice, but they've come back negative. They are stuck with me - they don't know what it wrong. Two consultants have seen me and I just feel they are going to fob me off as they don't know what to do.

Now, at this point I don't really do any exercise as it just causes tightness in my calf and the large tibial muscle. I also have what feels like bruising all on the side of my upper leg and my bottom muscles feel really tight. My legs just feel aching all the time, like there is restricted blood flow and they just need stretching all the time.

I go for sports massages every week (which is costing me a small fortune) and afterwards my legs feel quite good - but within a day they got back to how they usually feel. She is not medically trained, but she said my hamstrings feel tight which attach to the calf??

I just don't know what to do anymore - I can't do exercise like I love and and my legs feel like they are getting worse.

Help!

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[nmarman]

i see a lot of patients like this as i deal with a lot of runners. i beleive from your symptoms and history that your original injury was due ankle injury which may have stressed the medial ligaments and tendons. This would lead to repative instability and added stress on medial tibial ligaments. I would say: it seems you have chronic medial tibial stress syndrome that has now caused pain in the medial longitudial arch of the foot and concomitant tibial post/anterior and calf tightness - Through a compensation mechanism (very common in chronic condition).
The muscles need direct treatment to relax tension on tendons. Tendons themselves would need stimulus to repair.
I would do 4 treatments of shockwave theray to relax muscles and stimulate tendons, with ultrasound on tendons. combined with getting a custom brace for ankle.
normally a very sucessful protocol.

hope that helps

[pinkpussycat]

Thanks for your reply - in non technical terms - is this shin splints, but because I have carried on exercising it has tightened my tendons? When I went for my weekly sports massage last Friday the therapist was doing my inner thigh muscle and the inner bit of my knee - it was that painful it felt like she was massaging bruises!! Aswell as the tightness on exercising I get chronic aching in my legs ALL the time - it feels like there is loads of tension built up and I need to stretch them out. I'm not sure whether I'm just wasting my money on the massages as I've been for about 15 and go every week - i think that they are that tight I'm beyond stretching and massages

[nmarman]

Had a amatuer sprinter come in with chronic tightness in some muscles - we did shockwave on her to massage but also got her to foam roll in specific areas as well as getting the odd sports massage inbetween treatments. i would also look at your nutrion in a case like this and generally always put people on magnizium calcium and potassium suppliments in easy absorbable forms (malate).
she is getting much better and the muscle feel a lot better. are your sports ntherapy sessions worth it - well yes but you would be better off doing stretching, sports massage and shockwave all within a focused period but your condition is chronic dont expect it to go overnight.

there are many (4) reasons for shin splints the least common is bone actually cracking the most common is what you discribe.

[pinkpussycat]

I just thought with the massages, I would see more of a difference, but yes this has been going on for 4 years, so I think it will take some time to get better. It has been getting progressively worse as time has gone on. Tried going out on my bike the other day and then not only my legs were tightening up, but my lower back - I seem like a physical wreck at the age of 28! Yes, my sports massage person said about taking supplements, so I will give this a try. I think they are reluctant to give shock wave therapy on the NHS, so I'll probably have to go private.

[nmarman]

Yeah NHS is unlikely to pay, results i have got over 1.5years have beengreat in people who had chronic conditions but no one has done any studies onthis as yet as therapy is so new. fficeffice" />>>

Get the right supplements, and rest! While heating in baths of Epson salts (magnesiumsulphate), 1kg: 1 bath, and 30 min soak. If you are near London I can helpotherwise check internet for shockwave practitioners you might even find shortwave therapy helpful.>>
Good luck

[tennislegs]

Nmarman,

''Yeah NHS is unlikely to pay, results i have got over 1.5years have beengreat in people who had chronic conditions but no one has done any studies onthis as yet as therapy is so new. fficeffice" />>>''

If this is so new, and there are no studies to support it's use with chronic conditions how do you justify using it and not using an evidence-based approrach to your clients?

pinkpussycat, I work for the military and see an awful lot of these symptoms in soldiers who do weighted, booted runs and fast marching. It sounds like no-one has ever really got a handle on your symptoms.

I would recommend seeing a podiatrist who specialises in biomechanics. If your feet are pronated (flat, but this nothing to do with arch height!!) and need correcting with some kind insole, it is unlikely that your symptoms will improve without this being addressed. You say that you wear your comfy insoles in your running shoes only - you should aim to be wearing them all the time if your symptoms are that severe. Otherwise you will be re-irritating and stressing structures during the times that you do not wear them. MTSS and tightness of the ITB on your lateral thigh are closely linked with pronated feet.

Once this is sorted, it's worth going back to a physio to ensure that the muscular balance of the lower limb gets corrected. Look at tightness in the gastroc and soleus muscles and also if there is an ankle equinus - sometimes a Grade V manip of this can ease posterior calf tightness and stiffness at the Superior Tib-Fib joint. Techniques such as periostial pecking with an acupuncture meedle can also help in some cases.

I hope this helps. Keep us updated.

Laura

[nmarman]

Shock wave therapy has lots of great data especially for tendon pain 60%-80% of people improve significantly at 6 month follow ups.

However hasn't had the time to produce enough double blinded trial to appease N.I.C.E the advisory group to the NHS.

Although they have deem this treatment as safe. meaning they wont pay for it yet they wont pay for it.

I know the Help the hero centers have the devices and are finding the of great use in quickening rehab times in soldiers - ask them

[pinkpussycat]

Thanks for your comments Laura and Marman. I initially started at the 'Mobility Centre' in the NHS and at the time I went to get some as I kept going over on my ankle. When I started wearing the orthotics I started to get more problems, which made me think it was them causing it. The pain progressed to the shin, then tightness in my calf then the inner part of then knee (it feels bruised all the time), now its at the thigh and hips. Over the past 4 years I have gone back to the NHS and had more and more insoles. Apparently, I have mobile flat feet - so my arch only disappears when I put weight on my feet, but only because my ankle collapses over it. I feel more stable in my trainers when I wear them, but I cannot help thinking that all these problems have been caused by the orthotics - is this possible? I once went to a private biomechanical specialist and he said the NHS orthotics aren't very good, as there is no shock absorption and I should get his - not sure whether this was a marketing ploy though. I did go through a period of 3 months about 1 year ago where I wore them all the time - there was no difference in my symptoms.

The large tibial muscle on the front of my leg only appears when I flex my foot - this appeared about 1 year ago - not sure whether this has developed because of my othotics changing the way I walk? No one I have seen can seem to explain this

The MRI scan showed up tightness in the gastrocnemius - that's why they thought it was compartment syndrome - can this indicate something else?

Thanks

[pinkpussycat]

Also - I looked up Shock Wave Therapy and the Consultant I am under with the NHS has his own private practice and does this therapy! So, I will see what they say when they are supposed to be contacting me next week.

[nmarman]

if your ankle is so mobile I taken you where a support daily to stop re-aggravation. Orthotics change the way we load the feet. This change leads us to use different muscles so the large muscle may be because of the orthTics.

What side of leg is large tibial muscle?
What do you mean flex the foot? Curl foot or move ankle up/down?
What's your age and sex?

[pinkpussycat]

I don't wear an ankle support at all - as I thought the orthotics would control to pronation of my foot - but I am definitely going to look into getting some. Do you have them fitted or can you buy generic ones?

The large tibial muscle is on the outside of the leg at the front - on both legs. It appears when I pull my foot up towards my shin and is painful when I do this. It sometimes hurts when I drive as it constantly engages this muscle.

I'm female and 28 yrs old.

[physiobob]

I'd suggest starting again. Get rid of the orthotics (or retain a small arch support that is soft and comfortable), get some more neutral trainers as that's perhaps important. I'd then get someone to do a full neurological assessment of your lower limb, perhaps even to the point of EMG studies as your history is not pointing to much else other than an overactive tibialis anterior.

Can I be blunt and ask about your weight? The tibialis anterior muscle only really comes under load as you land on the foot (walking, running) as it try to control the foot slapping to the floor. This is the part of gait that needs assessing. There may be a neurological reason for the dysfunction or it may be simply that it is trying to cope with a larger body mass. You have a history or unstable ankles? If so, both ankles? And if so does your mother and grandmother have any such history?

[physiobob]

What's your age and sex?

You can see this type of information at the top of the post. Everyone should read that yellow box (Brief Medical History Overview) before anything else as it is important to have that information ahead of making any comments. Sometimes is contains some really important information.

[pinkpussycat]

Hi physiobob

Should I get more orthotics from the NHS or should I buy the ones you can get from shops that are generic? They sell some called 'Super Feet' at Cotswolds Camping Shop where I live.

I am going to buy some new trainers on Thursday and I'm thinking when they see me running they will probably try and sell me motion control trainers for over pronation - should I not go with these? When I stand for long periods of time without my insoles in my legs ache like mad, so I think they have got so used to them now that without them I end up aching. But it has always crossed my mind that the NHS have given me the wrong ones - but this would be difficult to prove.

I am 5ft5 and weigh 9 stone - so definitely not over weight - although the strain on my legs feels like I weigh loads! When I run I am definitely not a quiet runner - there is lots of slapping of my foot and when I have seen physios in ths NHS, one of them mentioned that I don't have a very good push off motion when I walk. I tried walking differently for over a month - nothing changed. I think because I have been to see so many different people and they have mentioned so many different things that could be wrong from - pronating feet, collapsing ankles, tight hip flexors. I'm just confused about what approach to take. This is why this problem has gone on for so long - I've gone through all the exercises I have been prescribed by the physio, I stretch every day, I don't do anything vigorous anymore and yet my legs ache so much I feel like there is reduced blood flow

I have hypermobility and I can do everything on the Beighton Criteria - not sure whether this could be relevant? I suffer in my upper back because of this as I have a desk job.

Hope someone can fathom this all out

[leahjrossi]

THANK YOU SO MUCH FOR POSTING THIS! Minus a few details, I am currently dealing with the same exact issue.

It's been about 3 years. I have always been an athlete, and after college I just ran about 45 minutes/day to keep in shape. At first I thought it was shin splints- but the pain got worse and now I am stagnant. So far I have had customized orthotics made (the podiatrist swore it was my feet), an EMG, and testing for compartment syndrome- both negative! I had a masseuse friend who would help me out my massaging my calves which helped a lot at first, but the next day its back again. I also saw a physical therapist who gave me abdominal exercises and ankle-strengthening and such. Didn't seem to make sense- or work.

It feels almost like I've done 1000 calf raises, or that my lower extremities are a rubber band that has been stretched to capacity! The doctors are clueless at this point. I was never a marathon runner, so I find it hard to believe that I strained my legs so much to this point. The pain is bilateral and main symptoms include: extremely tight calves (especially after trying to exercise), sore feet and ankles. I can only jog for about 5-10 minutes until the pain begins. After 15 minutes, its almost unbearable. I just want to get back to my normal self; I'm only 25 years old and this is definitely NOT NORMAL. Please help! Have you found out anything? Thank you in advance.

Leah

I will keep this brief as it's a long story!

4/5 years ago was fitted with NHS orthotics as they diagnosed me with flat feet - used to get a lot of shin pain and 'going over' on my ankle.

After orthotics still had the shin pain and started to get pain on the inside of both knees - went back over about 2 years to get different pairs of orthotics. Ended up with about 6 different pairs. Stayed with a pair that made me feel more stable in my ankles - only wear at the moment with my trainers (although these are motion control trainers, which technically if the orthotics did their job properly should I not have neutral ones?) and hiking boots as they don't fit easily in any other shoes. When I tried wearing them all the time, it made no difference to any of my symptoms.

Tried various things as I then started to get really really tight calves on exercising as well as the shin pain and inner knee pain - went to see a chiropractor as I also have upper back problems (but got hypermobility, so I think this is the reason for this). Then was referred for physio on the NHS, she went through various things - thought it was the way I walked, thought I need to strengthen my calves (at this point I was doing moderate exercise, so I don't think I need to strenghten them anymore!). I just felt like she was trying everthing. Then was referred to a consultant physio - she just worked on my 'flat feet', which it turns out it's actually my ankle joint that collapses in, as I have actually got an arch. I did various things with her - she tried strapping my ankles in the right place, had loads of exercises to do which were aimed at training myself not to roll my fee in and collapse my ankles.

So, after numerous visits to the phyio I was starting to despair. I have also developed an unusually large tibial muscle at the front of each leg - which when I show people - they are shocked! This only appears when I flex my foot up.

So, then this year I was referred to the orthopaedic dept at the hospital in Preston, Lancashire. They sent my for an MRI and apparently there is pressure in the gastronemius muscle (spelt right?) so they diagnosed what they thought was compartment syndrome. Was sent for the pressure tests - had these done twice, but they've come back negative. They are stuck with me - they don't know what it wrong. Two consultants have seen me and I just feel they are going to fob me off as they don't know what to do.

Now, at this point I don't really do any exercise as it just causes tightness in my calf and the large tibial muscle. I also have what feels like bruising all on the side of my upper leg and my bottom muscles feel really tight. My legs just feel aching all the time, like there is restricted blood flow and they just need stretching all the time.

I go for sports massages every week (which is costing me a small fortune) and afterwards my legs feel quite good - but within a day they got back to how they usually feel. She is not medically trained, but she said my hamstrings feel tight which attach to the calf??

I just don't know what to do anymore - I can't do exercise like I love and and my legs feel like they are getting worse.

Help!

[pinkpussycat]

I have replied back to Leah after receiving a private message. Not been on here that long, but thought I would post a message as there have been some developments on my leg problem and wondered if anyone had any views....

Since having MRI which showed up compartment syndrome and compression tests coming up negative, I had EMG tests done which showed an overactive anterior tibialis and under active calf. Also had shock wave therapy on lower leg - no difference. Also had acupuncture - no difference. Still have constant aching, feeling like I need to stretch and tightening of calves on exercise and if I stand for any amount of time. Have now been referred for an angiogram as physio thinks it could be popliteal artery entrapment syndrome. Consultant says this is very rare and normally don't have any symptoms at rest. I still wear my orthotics as tried 2 months without and my calves went really tight.

Any views?