Bilateral Lower Extremity Chronic Exertional Compartment Syndrome With Recurrent Symptoms After Prior Fasciotomy: A Case Report.

Chronic exertional compartment syndrome (CECS) is an exercise-related cause of lower extremity pain characterized by reproducible pain, tightness, cramping, and neurologic symptoms that improve with rest. Diagnosis may be delayed because chronic lower leg pain has a broad differential diagnosis, and currently used diagnostic strategies remain imperfect. We report the case of a young woman who began experiencing bilateral lower extremity pain during high school sports that progressed to pain with prolonged standing. Treadmill-provoked bilateral four-compartment pressure testing reproduced severe symptoms and demonstrated elevated pressures in multiple compartments after ten minutes of exertion, supporting the diagnosis of bilateral lower extremity CECS. She subsequently underwent bilateral four-compartment fasciotomy with initial symptom improvement. Several years later, she presented again with recurrent symptoms, new right ankle swelling, and neurologic findings that broadened the differential diagnosis beyond recurrent CECS. This case highlights the value of pressure testing in the initial diagnosis of CECS, the possibility of persistent or recurrent symptoms after fasciotomy, and the importance of reconsidering vascular and neurologic alternatives when patients return with symptoms after prior decompression.