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. If symptoms recur after fasciotomy, they can usually be traced to the deep posterior compartment, particularly if this compartment was not adequately released. Although some patients have recurrent symptoms related to inadequate release, a soleus bridge, scarring over of the fasciotomy defect, or entrapment of the saphenous nerve in the scar, in some patients the cause of these symptoms remains unclear. If fasciotomy fails, the diagnosis of ECS should be fully reevaluated.