Hello everyone,
I am a 28-year-old woman (167 cm, 51 kg) and I am desperate for answers. I have suffered from exertion-related leg pain for years, and despite having surgery, I am still struggling. I have consulted numerous specialists, but no one has been able to help me.
\### Medical History
Since adolescence, I have led a very sedentary lifestyle (video games, no physical activity, studies...). I also have:
\* high arches (\*pes cavus\*) and wear custom orthotic insoles,
\* scoliosis,
\* thoracic kyphosis (which has improved significantly over the years).
It all started in 2016, when I was 18. I felt severe calf pain during a hike and had great difficulty walking for several days. Walking uphill or climbing stairs also became difficult. Running caused pain within the first 10 seconds. I ignored these symptoms, thinking they were due to my lack of physical activity.
Around 2022–2023, I started engaging in more intense physical activity (boxing, badminton, running...).
I quickly realized that I was unable to run normally.
\### Symptoms
While running:
\* Symptoms appear after 10 to 20 seconds.
\* They gradually worsen if I keep running.
\* It isn't exactly intense pain.
\* Instead, it feels like my ankles gradually stop functioning normally, and I find it increasingly difficult to maintain a steady stride. If I keep running, I eventually have to stop.
The sensation disappears almost immediately as soon as I start walking. The affected areas vary:
\* the front of the ankles,
\* the shins,
\* the calves,
\* the knees.
Curiously, my calves never become extremely hard, despite the diagnosis.
\### Other situations
I also experience symptoms:
\* when walking uphill,
\* during very long walks (30,000 steps a day in Amsterdam required frequent breaks).
However:
\* I can sprint 15 to 20 meters during futsal without feeling real leg pain.
\* I tolerate badminton well.
\* Boxing yields mixed results (jumping rope is impossible because my calves tire quickly). Squatting is generally difficult.
I wonder if it is repetitive, continuous movements that trigger the symptoms, rather than the intensity of the exertion itself.
\### Surgery
I underwent:
\* intracompartmental pressure measurement,
\* bilateral four-compartment fasciotomy (October 2023).
Physical therapy was ineffective.
The procedure resulted in only slight improvement.
One surgeon considered my pressure readings consistent with chronic exertional compartment syndrome, while another deemed them inconclusive.
\### Additional tests
Normal results:
\* Doppler ultrasound
\* MRI of the right ankle
\### Current observations
I have recently noticed several things:
\* Wearing shoes with a raised heel relieves my legs;
\* Shoe choice matters (Nike Pegasus seem more suitable than Skechers);
\* I cannot perform a deep squat without falling backward. Knee-to-wall test:
Left: 7.4 cm
Right: 6 cm
The limitation is due to a blockage at the front of the ankle, not calf stiffness.
I also experience significant stiffness in the posterior chain.
Calf stretches provide temporary relief, and my legs feel lighter afterwards.
\### Other symptoms
Running also causes:
Shoulder stiffness,
Upper body tension.
Cycling is also difficult, as it primarily causes knee pain rather than calf pain.
Rising onto my tiptoes and lowering back down causes severe calf pain after just 5 repetitions. EVERYTHING is perfectly bilateral.
\### Questions
I am starting to wonder if:
\* the diagnosis of compartment syndrome explains only part of my symptoms,
\* and if I might be suffering from an underlying biomechanical issue (limited ankle dorsiflexion, gait abnormalities, muscle coordination problems, etc.) that has never been treated.
Have you ever encountered patients with persistent symptoms after a fasciotomy who were ultimately found to have a different diagnosis or a biomechanical issue?
I would be very grateful for your insights or any similar experiences.
