Superficial peroneal nerve paresthesias may be secondary to ischemic change in the lateral compartment as well as local compression from fascial hernias in either the lateral or anterior compartments. Typical Clinical Presentation Acute ECS causes agonizing pain, tense swelling, and pain on passive stretch of the involved muscles. People who experience chronic ECS report a gradual onset of aching leg pain and a feeling of fullness, both over the involved compartments. Activity-related pain begins at a predictable time after starting exercise or after reaching a certain intensity level. The pain is always fully relieved by rest, usually within 20 minutes of exercise completion, only to recur on resuming exercise.
Patients occasionally report paresthesia in the leg and dorsum of the foot during exercise.
Many patients who experience symptoms of anterior compartment pain will have demonstrable fascial defects or hernias, usually in the distal third of the leg over the intramuscular septum. Physical examination in chronic ECS is usually normal unless the patient has recently exercised. Therefore, performing the physical exam after the patient has exercised strenuously enough to reproduce symptoms is recommended. Such exercise will produce swelling and tension in the involved compartments and increased leg girth. The leg will be tender over the involved muscles, and, with severe ECS, the patient will exhibit muscle weakness and paresthesia to light touch.