Thursday, April 14, 2011

Compartment syndrome

More on the adventures of the Stupid Calves that Hurt When I Run--

Trigger warning: If you are easily squicked out by medical stuff, you have been warned.  Nothing too squicky, in my opinion, but I don't want to assume everyone has similar squick levels.

I had my appointment this morning with a podiatrist.  The great news is that she didn't believe that my ridiculously flat feet were contributing to my calf pain.  Because I got new shoes with high arch inserts, and the combination didn't solve the problem, it's not my feet.

Great, right?  Aren't I SO glad I don't have to do really easy exercises to bring my arches back up?  Or buy shoes with arch support?  I mean, because that's so very difficult for me to do.

The doctor believes, based on my symptoms, that I have exercise-induced chronic compartment syndrome.  Please do not put yourself through the squicky horror that is looking it up on the internets.  After doing just that, and feeling very freaked and squicked out, I can tell you some information about compartment syndrome, and I can tell you that my symptoms fit it really well.

Your muscles are all surrounded by a layer of fascia.  In the case of my calves, the fascia surrounding my calf muscles, tendons, ligaments, nerves, blood vessels, etc., is a certain size.  Specifically, a size too small for my calves (which, if you've seem them, are HUGE).  So as I run, the calves are too big for the surrounding fascia, and so I get a huge build-up of pressure in that "compartment" made by the fascia.  The pressure can result in nerve damage, ischemia, and tissue death if untreated, although since this would be chronic exercise-induced compartment syndrome, it would only result in those very serious things if I kept running through the pain for a significant amount of time on a regular basis.

However, the reason why I think that this is the right diagnosis, as opposed to a gastrocnemius strain, is that a muscle strain wouldn't explain my weird vascular symptoms.  Compartment syndrome easily does.  That is, when I experience the symptoms when I run, one of the major things I've noticed is that my calves almost always feel better after I rub them a lot and help increase blood flow.  Additionally, on a handful of occasions where I've made a significant effort to push through the pain, I end up feeling extremely light-headed, and twice I almost passed out because of it.  If I were just straining my muscles, I wouldn't have such terrifyingly odd circulation symptoms.

Like I said, compartment syndrome explains it.

So, what's next?  I should get a phone call either today or tomorrow from a sports medicine MD out west (not far out west, just not in Boston).  I'll go to see him, and he'll run the test for compartment syndrome.  In order to conduct the test, I'll have to get the symptoms started.  So in preparation, I'll probably go running a few times (yay!) in advance, and then go running at the appointment during the test.  That'll induce the symptoms, and then they will stick some needles into both of my calves.  Using these needles, they'll measure the pressure inside the compartment.  If it's high enough, then that confirms the diagnosis.  Voila.

I don't find the test very squicky, and to be honest, I'm actually looking forward to being able to run, or more specifically, being required to run.  I miss running very much.  I also like having tests done because they provide answers.  I like answers!

The treatment squicks me out, though.  First of all, because this isn't acute compartment syndrome, my doctors might decide the treatment is elective (because I'm not risking the loss of limb or death of tissue).  It's not as if I HAVE to run.  I've demonstrated that if I don't run, I don't experience symptoms, or at least not often enough to warrant treatment.  But this view makes me extremely uncomfortable.  Not only does it not fix the actual problem (I'll still have the problem, just sitting there, waiting to spring out at me), but I'm not confident that I'll be able to live the rest of my life without participating in physical activities that will induce symptoms.  I'm not just making silly jokes about running away from zombies.  At this point in my life, sure, I can go to the gym to work out, and this gym has ellipticals.  And I can afford the gym.  But I'm not always going to be in this place in my life.  And I think that the emotional effects of never running again are going to be pretty serious.  I've been viewing my calves as a problem that can be fixed, not as a reason not to run.

So what is the treatment?  It's called a fasciotomy.  It's a surgery where the doctor will open up my calves.  No, really.  Once the pressure is released (not sure how long that would take; for acute compartment syndrome, it's apparently long enough that there are some excruciatingly squicky images of people with open incisions or missing skin, and they're clearly not still in surgery), the doctor would sew everything back up except the fascia.  The fascia would remain open.

The way it works is that nothing's going to be ruined.  My calves will still be inside my legs and skin, just able to expand.  With the fascia closed, that's not possible right now, and instead of expanding outward, they just crush everything.  I would eventually be able to run again, with the only possible side-effect being that MAYBE there would be some ugly-looking bulging that doesn't actually signify a health problem.  The bulging, if it occurred, would only happen while exercising, and would just be a result of the fascia being open.

I find the treatment a bit worrisome because there's always the chance that the compartment syndrome could come back (although it's not too high), and because I'm not sure it'll feel worth it to go through so much and spend so much time in physical therapy if I fail to be a runner for the rest of my life.

Weirdly enough, it almost feels as though I'm going to have to choose between committing to running for the rest of my life, or never ever run again.

I think I'd go for the surgery, as long as it wouldn't interfere too much life-wise (that is, maybe if I got it right at the beginning of August, when I leave work, and then be able to walk easily by the time I have to start graduate school).  And of course, it's something to discuss with all of my doctors and with my family.

"But wait!" you say.  "You haven't gotten the test yet!  You always think you have something and you're always wrong!"

That's a fair protest.  I do tend to self-diagnose, and I'm not usually right.  When I had colitis, I thought it was a parasitic infection.  And with my calves, I thought I had some kind of vascular disease (although as you can now see, I wasn't wrong about the vascular symptoms!).  But let's be clear about a few things:

Compartment syndrome fits all of my symptoms.  In fact, it fits them better than any other possible health problem I've looked up.  It explains why my symptoms didn't occur right away when I first started running.  It explains why the pain has gotten more frequent than before.  It explains why stretching doesn't help, why taking it slow doesn't help, or why new shoes with excellent insoles haven't helped.  It's the right "type" of pain, and the right location.  And it does the one thing that wasn't explained by any other kind of diagnosis are the vascular symptoms.  How does calf pain translate to lightheadedness (that isn't caused by a low pain tolerance)?

Additionally, the podiatrist I saw today is very much convinced that I have compartment syndrome.  She examined my feet and calves and found that there was some unusual tightness in my calves that wouldn't be there otherwise.  She's ruled out my feet as the problem as well.

She also explained that in her entire career, she has only sent two patients to be tested for this very rare problem.  One of them had a negative test, and one of them had a positive test.  Basically, if she wasn't convinced I have it, she wouldn't be sending me to get the test right away.  So I think it's pretty clear.

We'll see what happens.  It's pretty nervous-making on my end.  I just figured I'd either have to do PT for my calves, or some exercises to fix my arches.  Looks like I was wrongitty-wrong wrong!

(For those of you who are confused by the use of the word "squick" and its derivative forms, it's essentially the sort of grossed out cringe-y feeling you sometimes get.  It's less visceral than "EWW, GROSS!" followed by vomit, but definitely not the same as "creepy."  It's like when you see something that makes you feel uncomfortable, in a weird cringe-y way.)


  1. Hi there!

    Stumbled on this blog by chance, while searching for info on compartment syndrome since I was diagnosed with it about two months ago.

    Not to sound creepy, I couldn't help but notice that you're a Tufts grad! I'll be a sophomore there in the fall and you're now the 5th other person I know of from Tufts who's had CECS, which I find, statistically, rather interesting.

    If you don't mind me asking, how did your test turn out?

  2. Thanks for the comment, xliarsenicxx! That's so weird that there are so many people who went to Tufts/go to Tufts who are ending up with compartment syndrome. I wonder if it's from running the hills, maybe? My friend who is a massage therapist thinks that I must have pushed myself too hard, which I don't believe (or want to believe). I'm going to ask the surgeon when I meet with him at the end of the month.

    My test turned out very positive, although I didn't get the exact numbers. It was, as I expected, worse in my right leg than in my left. Three out of four compartments (not the lateral on either side). I'm seeing a surgeon soon, and I hope to have surgery this August.

    Have you decided to get surgery, or to try another treatment? Or to try no treatment? My family was VERY much for no treatment, insisting that I just stop any activity that aggravated my symptoms. Now that my symptoms are surfacing from the elliptical and from powerwalking, I will need surgery, but I was planning on having it anyway!

  3. Hello, Just found this while I was doing a search for Compartment syndrome. Who did you surgery, and are you pleased with the results. I just scheduled my surgery for next month.