Deep posterior chronic exertional compartment syndrome as a cause of leg pain

  • Michiel Winkes
  • Percy van Eerten
  • Marc ScheltingaEmail author


A small proportion of patients with exertional leg pain (ELP) have deep posterior chronic exertional compartment syndrome (dp-CECS). These individuals report pain, tightness and cramps deep in the calf muscles that are elicited by exercise, but may also be present during rest to a lesser extent. Physical examination often reveals painful palpation of the flexor muscles in the area immediately dorsomedial to the tibial bone. Diagnosis is confirmed by intracompartmental pressure testing. Various entities may mimic or coincide with dp-CECS, including medial tibial stress syndrome (MTSS) and popliteal artery entrapment syndrome (PAES). Fasciotomy of multiple flexor muscles is the only treatment that achieves a beneficial outcome. The aim of this overview is to discuss the diagnosis and management of dp-CECS.


Fasciotomy Tibia Exertional leg pain Deep flexors 

Tiefes, posteriores chronisches belastungsinduziertes Kompartmentsyndrom als Ursache von Beinschmerz


Bei einem kleinen Anteil der Patienten mit belastungsinduziertem Beinschmerz liegt ein tiefes, posteriores chronisches belastungsinduziertes Kompartmentsyndrom (tp-CBKS) vor. Die Betroffenen geben Schmerz, Verkürzungen und Krämpfe tief in den Wadenmuskeln an, die durch körperliche Aktivität hervorgerufen werden, aber in geringerem Maße auch in Ruhe bestehen können. Die körperliche Untersuchung ergibt häufig eine schmerzhafte Palpation der Flexoren im Bereich unmittelbar dorsomedial zur Tibia. Die Diagnose wird mithilfe der intrakompartimentellen Druckmessung gesichert. Verschiedene Krankheitsentitäten können sich ähnlich präsentieren oder mit dem tp-CBKS zusammenfallen, so etwa das Schienbeinkantensyndrom und das Popliteakompressionssyndrom. Die Fasziotomie mehrerer Flexoren ist die einzige Therapieoption mit positivem Behandlungsergebnis. In der vorliegenden Übersicht werden Diagnose und Therapie des tp-CBKS diskutiert.


Fasziotomie Schienbein Belastungsinduzierter Beinschmerz Tiefe Flexoren 


Compliance with ethical guidelines

Conflict of interest

M. Winkes, P. van Eerten and M. Scheltinga declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

The supplement containing this article is not sponsored by the industry.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Michiel Winkes
    • 1
  • Percy van Eerten
    • 1
  • Marc Scheltinga
    • 1
    Email author
  1. 1.Máxima Medical CenterVeldhovenThe Netherlands

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