Anterior (Tibial) Compartment Syndrome

The anterior (tibial) compartment syndrome, also called anterior or lateral shin splints, usually occurs when a runner changes from a flatfooted to a toe-running style, begins interval training on a track or hill, or runs in a shoe with a sole that is too flexible. All of these activities overload the anterior compartment muscles, producing pain in the antero-lateral area of the leg along the extensor tendons of the ankle and foot (see diagram). Anterior compartment syndrome caused by a segmental artery spasm or by ischaemia of the muscles and nerves from increased tension in the fascial compartment is rare in runners.

TREATMENT

Successful treatment may include proper training technique (wearing good shoes, running on a level surface, no excessive hill or speed work), stretching exercises and strengthening exercises for the anterior compartment musculature, physiotherapy treatmentincluding a range of modalities and ice treatment at home. A runner with a chronic or long standing injury may require fasciotomy (which will allow more room for muscle swelling in the anterior compartment).

If the symptoms do not respond to therapy, a tibial or fibular stress fracture should be suspected. Conditions that simulate shin splints and the compartment syndromes (e.g. thrombophlebitis, osteomyelitis, cellulitis, tumours and intermittent claudication) are rarely seen in runners but should be considered.

Cross-section through anterior and lateral compartments of leg

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