The painful chronic anterior lower leg syndrome. A prospective clinical and experimental study.

A presumed painful chronic anterior lower leg syndrome was diagnosed in 51 patients (73 legs), 30 women and 21 men, aged 11 to 70 years, over a 2-year period. The duration of the syndrome varied from 1 month to 10 years. The patients' main complaint was pain when walking located in the medial ventral muscle compartment of the lower leg. In addition 10 of the patients (15 legs) had leg pain at rest as well and 12 (15 legs) had paresis of the extensor muscles. Thirty-four paired intracompartmental pressure recordings with the wick technique in 6 patients suggest that the more severe the syndrome the lower the pressure in the tibialis anterior muscle. Blind diathermic fasciotomy in 25 patients (36 legs) with a typical history relieved the pain and paresis completely or partly in 33 (92 per cent) out of 36 legs. No postoperative complications worth mentioning were observed. It is concluded that: 1) a chronic painful anterior lower leg syndrome should be suspected in patients with pain on walking and at rest located in the ventral part of the lower leg; 2) intracompartmental pressure measurements seem to be of little preoperative diagnostic value in non-selected patients; 3) blind diathermic fasciotomy of the anterior, medial compartment of the lower leg, including the extensor retinaculum, gives relief from pain and paresis in most patients with a typical history.