The most obvious answer to pain and tightness in the calves is cramps or a tight muscle/tendon.  What can happen in some individuals is this pain that consistently begins after a given period of walking or running.  This pain can be severe enough to stop someone in their tracks and can even cause radiating symptoms including burning or numbness.  The condition I am refering to is called chronic exertional compartment syndrome.

If you have ever heard of compartment syndrome before, you may associate this condition with big injuries - those that occur in car accidents or a fall from a height.  Traditional compartment syndrome is a condition in which a traumatic incident occurs that causes a lot of swelling within the groups of muscles underneath the skin.  This swelling in injuries is usually due to a buildup of blood and in cases of an acute traumatic injury, this is a medical emergency that merits timely surgical intervention.  When there is a high level of swelling within these compartments, it puts a tremendous amount of pressure on the vessels and muscles which can actually cause necrosis - or death of the muscles and nerves which is nearly impossible to reverse.

In chronic exertional compartment syndrome, a person with a high level of activity will typically notice that, after a predictably distance or time, they develop a lot of tightness and pain and sometimes even numbness in the calf/ankle/foot.  This pain tends to subside with time of rest.  However, it returns if the same activity is performed again for this same period of time.  In more severe cases, a person may experience a weakness within the calf or even foot drop. 

Causes of chronic exertional compartment syndrome sometimes have to do with your biomechanics, or the way your body functions when walking/running.  It also is a reflection of your specific anatomy, whether you have tighter and less forgiving septae (the tissue that binds each compartment of muscles together).

In order to diagnose this condition, a test is performed in which the compartment pressures within the legs are measured at rest and then after a period of exercise.  If the compartment pressures are normal at rest, but elevated beyond normal constraints with exercise, this indicates chronic compartment syndrome.  Testing to rule out other causes of calf pain are typically performed first, including x-rays to rule out stress fractures and sometimes MRI to assess the condition of the muscles and tendons.

Initial conservative treatments include pain relievers, massage, orthotics, stretching and strengthening and temporary rest from activity.  If the condition is not well managed with these methods, surgery to release these compartments can be performed, followed by use of compression stockings.

If you are experiencing pain in your legs or numbness that radiates from the leg into the foot, make an appointment with us today for an initial assessment.  If there are indications of chronic exertional compartment syndrome, you may need referral for testing or treatment from a vascular doctor.  The sooner this problem is addressed, the less likely complications will follow.