Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature.

Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps. Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard. Management includes both conservative and surgical options. Conservative treatment includes gait re-training and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities. This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve.

BACKGROUND: Minimally invasive surgery has a shorter surgical time, and in this study we focus on minimally invasive distal metatarsal metaphyseal osteotomy (DMMO). The operation seems to be less complex but requires a high learning curve. We report on our first patients to underline the need for extensive training and great awareness for the risks in the early learning stages. METHODS: We evaluated 27 patients (mean age = 60.9 years) with a mean follow-up time of 7.2 months. Indication was metatarsalgia, intractable plantar keratosis, and the (sub-)luxation of the metatarsophalangeal joint. Clinical results were evaluated with the 12-item Short Form (SF-12), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the American Orthopaedic Foot and Ankle Score (AOFAS). Radiographs and pedobarographic analysis were obtained. RESULTS: Scores ranged closely to standard value (AOFAS 88.07 points; FFI 93%; FAAM 36.4 points; SF-12 31.27 points). Pedobarography showed significant differences in several forefoot areas. We encountered nonunion/malunion and necrosis of the metatarsal head. CONCLUSIONS: The aim of this study was to demonstrate the need for intensive training before practicing DMMO. Results show that minimally invasive DMMO requires a high learning curve. Correct handling of the burr is associated with a lot of training. Wrong handling can lead to nonunion/malunion or necrosis. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.