It involves a condition of elevated pressure in the lower legs resulting from the swelling of a muscle that no longer has room in its surrounding muscle tissue. The ailment is well known among active athletes, but it had previously never been described in diabetics. It is reminiscent of so-called intermittent claudication (involving obstructed blood flow) with increasing pain in the lower legs during walking that then disappears in rest.
Those affected are primarily middle-aged women with long-term diabetes. In many cases they have not been able to walk more than a few hundred metres before the pain forces them to stop. It was previously believed that these diabetics had symptoms of intermittent claudication in the form of constrictions in the blood vessels of the legs, and they were prescribed exercise, which merely aggravated the pain.
When examined, the patients have firm lower leg musculature with a normal pulse, but they develop lower leg pain after 20 heel-raisings due to the dramatically elevated muscular pressure. The treatment involves a surgical procedure (fasciotomy) to split the muscle membrane, which in general is whitish and thickened. The vast majority could walk without restrictions following the surgery, which is especially important for diabetics, since exercise is a key part of treatment for their underlying disease.
The cause of the rise in pressure in the musculature in chronic compartment syndrome is unknown, so muscle samples obtained were examined one year later in a microscope. In otherwise healthy and active patients with chronic compartment syndrome, there was a decrease in the number of the smallest blood vessels (capillaries), which can have contributed to the rise in pressure.
Diabetics with compartment syndrome demonstrate no decline in the number of capillaries, but they have the same changes in their muscles as when there is a severe lack of oxygen. After one year, the otherwise healthy individuals with chronic compartment syndrome still had a low number of capillaries despite an expected increase in physical activity after the surgical procedure. In diabetics with chronic compartment syndrome, the advanced changes in muscles had almost completely healed one year after the treatment. The diagnosis is easy to make in diabetics, but it is important to verify with pressure measurement before operating, due to the increased risk of complications.
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On Friday 28 May, David Edmundsson, Dept. of Surgical and Perioperative Sciences, Umeå University, will defend his dissertation titled Chronic compartment syndrome of the lower leg.
The defence will take place at 1 pm at the School of Dentistry, Norrlands University Hospital, Level 9, Room B.
The faculty opponent is Professor Jorma Styf, University of Gothenburg.
The complete dissertation and abstract can be downloaded at:
Author: Hans Fällman