Leg and foot pain in a female ballet dancer caused by combined bilateral chronic compartment syndrome and bilateral tarsal tunnel syndrome. A case report
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http://orcid.org/0000-0002-7172-9005
Lisbeth - Hasslan Bischoff, MSc
Jane Paris, MA
Abstract
A 24-year-old professional elite female ballet dancer developed intolerable leg pain that threatened her career. She was diagnosed with bilateral chronic compartment syndrome of the lower legs and a minimal degree of coexisting bilateral tarsal tunnel syndrome - overlapping conditions that can complicate diagnosis and treatment in athletes and performers with exceptionally high physical demands.
Fasciotomy was performed on all four compartments in both legs. Additional treatment included repeated injections of Marcaine and cortisone along the medial tibiae for shin splints and six months of structured rehabilitation, resulting in a return to high-level performance in a leading contemporary ballet role.
Two years later, the patient sustained a stress injury to the first tarsometatarsal joint, requiring eight weeks away from training and dance. After returning to activity, previously mild tarsal tunnel symptoms worsened and prohibited continued performance.
Because conservative treatment was unsuccessful, bilateral tarsal tunnel decompression was performed, leading to rapid and complete pain relief. Following four months of rehabilitation, the dancer returned successfully to a principal role in a classical ballet requiring extensive pointe work. More than seven years after the final surgery, no further complications were reported.
This case highlights the diagnostic complexity of lower extremity pain syndromes in high-performance athletes and dancers and underscores the importance of long-term follow-up and reassessment when symptoms recur.
Cues for recognizing these conditions are that physical training and medication, usually recommended for muscular pain, regularly leads to increased local pain, cramps in legs and feet and referred pain whilst relief is achieved by rest only
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References
2. Vogt P. Ischemic necrosis following marching. Read before the Oregon State Medical Society; 1943.
3. Renemann RS. The anterior and the lateral compartment syndrome of the leg due to intensive use of muscles. Clin Orthop Relat Res 1975;113:69-80.
4. George CA, Hutchinson MR. Chronic exertional compartment syndrome. Clin Sports Med 2012 Apr;31(2):307-19. doi: 10.1016/j.csm.2011.09.013. Review.
5. Vajapey S, Miller TL. Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature. Phys Sportsmed 2017, Nov;45(4):391-398. doi: 10.1080/00913847.2017.1384289. Epub 2017 Oct 3. Review.
6. Clanton TO, Solcher BW. Chronic leg pain in the athlete. Clin Sports Med 1994;13:743-59.
7. Fraipont MJ, Adamson GJ. Chronic exertional compartment syndrome. J Am Acad Orthop Surg 2003;11:268-76.
8. Micheli LJ, Solomon R, Solomon J, Plasschaert VFP, Mitchell R. Surgical treatment for chronic lower-leg compartment syndrome in young female athletes. Am J Sports Med 1999;27:197-201.
9. Roberts A, Franklyn-Miller A. The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review. Scand J Med Sci Sports 2012 Oct;22(5):585-95. doi: 10.1111/j.1600-0838.2011.01386.x. Epub 2011 Sep 13. Review.
10. Tucker AK. Chronic exertional compartment syndrome of the leg. Curr Rev Musculoskelet Med 2010;3:32-37.
11. Bong MR, Polatsch DB, Jazrawi LM, Rokito AS. Chronic exertional compartment syndrome: diagnosis and management. Bull Hosp Jt Dis 2005;62(3-4):77-84. Review.
12. Edmundsson D, Toolanen G, Sojka P. Chronic compartment syndrome also affects nonathletic subjects: a prospective study of 63 cases with exercise-induced lower leg pain. Acta Orthop 2007;78:136-142.
13. Orlin JR, Øen J, Andersen JR. Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study. J Orthop Surg Res 2013;8/1/6:1-7. (www.josr-online.com/content/8/1/6).
14. Orlin JR, Lied IH, Stranden E, Irgens HU, Andersen JR. Prevalence of chronic compartment syndrome of the legs: Implications for clinical diagnostic criteria and therapy. Scand J Pain 2016; 12:7-12.
15. Orlin JR, Øen J, Andersen JR et al. Leg cramps in pregnancy caused by chronic compartment syndrome and relieved by fasciotomy after childbirth. Clin Case Reports June 2014;2(3):103-7. (http://onlinelibrary.wiley.com/doi/10.1002/ccr3.73/full)
16. Dunn JC, Waterman BR. Chronic exertional compartment syndrome of the leg in the military. Review. Clin Sports Med 2014 Oct;33(4):693-705.
17. Due J, Orlin JR, Bjørang T. Anterior compartment syndrome. Tidsskr Nor Lægeforen 1978;29(98):1449-51.
18. Kiel J, Kaiser K. Tarsal tunnel syndrome. In: Stat Pearls (internet). Treasure Island (FL): StatPearls Publishing 2024 Feb 9. PMID:30020645. Bookshelf ID: NBK513273. Free Books & Documents.
19. Bailie DS, Kelikian AS. Tarsal tunnel syndrome: diagnosis, surgical technique and functional outcome. Foot Ankle Int 1998;19(2):65-72. (https://doi.org/10.1177/107110079801900203).
20. Rinkel WD, Cabezas MC, van Neck JW, Birnie E, Hovious SER, Coert JH. Validity of the Tinel Sign and Prevalence of Tibial Nerve Entrapment at the Tarsal Tunnel in Both Diabetic and Non-diabetic Subjects: A Cross-Sectional Study. Plast Reconstruct Surg 2018 Nov,142(5):1258-1266. Doi: 10.1097/PRS 0000000000004839.
21. Bodner G. Nerve compression syndromes. In: high-resolution sonography of the peripheral nervous system. 2nd edition. Edited by Peer S, Bodner G. Berlin-Heidelberg: Springer; 2010:71-122.
22. Schubert AG. Exertional compartment syndrome: review of the literature and proposed rehabilitation guidelines following surgical release. Int J Sports Phys Ther 2011;6(2):126-140.
23. Stubhaug A, Breivik H. Chronic compartment syndrome is an under-recognized cause of leg-pain. Scand J Pain 2016; 12:53-4.
24. Iborra A, Villanueva M, Sanz-Ruiz P. Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months. J Orthop Surg Res 2020;15(30):1-6. (https://doi.org/10.1186/s13018-020-1559-1).
25. McSweeney SC, Cichero M. Tarsal tunnel syndrome – a narrative literature review. Foot (Edinb) 2015 Dec;25(4):244-50. (doi: 10.1016/j.foot.2015.08.008).
26. Orlin JR, Stranden E, Slagsvold C-E. Effects of mechanical irritation on the autonomic part of the median nerve. Eur J Neurol 2006; 12:144-149.
27. Lovelock T, Claydon M, Dean A. Functional Popliteal Artery Entrapment Syndrome: An Approach to Diagnosis and Management. Intern J Sports Med 2021;42(13):1159-1166. (DOI: 10.1055/a-1524-1703).
28. Molund M, Husebye EE, Hellesnes J, Nilsen F, Hvaal K. Proximal medial gastrocnemius recession and stretching versus stretching as treatment of chronic plantar heel pain. Foot Ankle Int 2018 Dec;39(12):1423-1431. (DOI: 10.1177/1971100718794659).
29. Williams E, Rosson G, Hagan RR, Hashemi SS, Dellon AL. Soleal Sling Syndrome (Proximal Tibial Nerve Compression). Results of Surgical Decompression. Plast Reconstruct Surg 2012;129(2):454-462.
30. Molnar M. Stress fracture of the second metatarsal: a case report. JDMS 1997;1(1):22-24.
31. Hasslan-Bischoff L, Paris J. A professional dancer’s rehabilitation after bilateral fascial release surgery for chronic exertional compartment syndrome (Poster). Exhibited at the International Association for Dance Medicine & Science 28th Annual Conference. Helsinki, Finland. 25.-28. October 2018.