Case Study: Bilateral Compartment Release

23 year old college senior underwent elective bilateral anterior/lateral compartment releases due to exertional compartment syndrome. He started outpatient physical therapy approximately 3 weeks postoperatively. The biggest issue at start of physical therapy was mild drop foot on the right with continued swelling and tightness in the right anterior compartment. He is an active runner, plays ultimate Frisbee and basketball, and would like to return back to prior level of function.

• Decrease right leg swelling
• Develop a normal gait pattern
• Progressively improve hip and core strength and proprioception
• Return to normal walking program and be able to ambulate on even and uneven surfaces with multiple speeds and angles without symptoms
• Return back to running, playing basketball and ultimate Frisbee

I.  Plan

• Patient is a pleasant 23–year-old college senior who had a significant history of bilateral anterior and lateral leg pain with running for 6 months before seeking medical treatment.
• He had his compartment pressures checked and level was elevated in all compartments, but specifically the anterior/lateral compartments bilaterally, and patient elected to undergo bilateral compartment release.
• Patient underwent a bilateral anterior/lateral compartment release but required a second operation to evacuate a hematoma in the right leg about one week after the initial operations. He started physical therapy after incisions were fully healed, approximately 3 weeks after his second surgery.
• Patient’s biggest complaints were shin tightness bilaterally (worse on the right than the left), stiffness to bilateral shins, and difficulty with third and fourth toe extension on the right with activity or with walking. Incline on the AlterG was maintained initially at 0 degrees in order to minimize stress on the anterior and lateral compartment muscles.
• At his first follow up visit, we initiated gait training on the AlterG Anti-Gravity Treadmill, soft tissue mobilization (ASTYM), ankle mobilization drills, lower extremity flexibility drills, hip and core stability exercises, and modalities/ biofeedback to help with pain and swelling. Advanced proprioception exercises were incorporated as he progressed through his rehabilitation.
• Program duration was 9 weeks.

II.  Considerations

• Pain, swelling, and soreness were considered when progressing ambulation on the Alter G.
• Speed and incline were increased as patient’s pain level improved.