Skin incisions are left open to keep intracompartmental pressure low, and delayed closure is performed 48 to 72 hours later. When a patient first reports chronic ECS, we almost always begin nonoperative treatment and address extrinsic and intrinsic contributing factors. Extrinsic factors include training surface, shoe design, and training intensity, all of which can be modified. These modifications are not always successful, although orthoses do decrease hyperpronation and thereby decrease compression of the deep posterior compartment by the soleus bridge. Once a patient presents with chronic ECS, however, it is difficult to modify all these factors.
Athletes routinely remain symptomatic unless they abstain from symptom-producing activities.
If symptoms persist for 3 months, fasciotomy is recommended for chronic ECS and, unlike fasciotomy for acute ECS, may be limited to complete release of the involved compartments. The results of anterior and lateral compartment releases are superior to those of posterior releases in most studies. Weight bearing is begun within the first week. Athletes begin exercise on a stationary bicycle at 2 weeks and gentle isokinetic strengthening exercises at 3 to 4 weeks postoperatively. They begin running at 5 to 6 weeks, with speed and agility drills at 8 weeks.