October 7, 2025 | Podiatry Help

Anterior Compartment Syndrome occurs during sport when the muscle size expands from the activity and the tightness of the fascial sheath around the muscles prevents the muscle expanding resulting in pain.

Anterior compartment syndrome is a condition often seen in runners, characterized by increased pressure within the anterior compartment of the lower leg. This area contains muscles such as the tibialis anterior, extensor hallucis longus, and extensor digitorum longus, along with blood vessels and nerves. When runners engage in repetitive, high-impact activities, swelling or bleeding can occur within this enclosed space, elevating intracompartmental pressure. Because the fascia surrounding the muscles is non-elastic, the pressure can compromise circulation and nerve function, leading to significant pain and dysfunction.

There are two main forms relevant to runners: acute compartment syndrome and chronic exertional compartment syndrome (CECS). Acute compartment syndrome is a medical emergency, usually arising from trauma like a fracture, and requires immediate surgical intervention. Chronic exertional compartment syndrome, on the other hand, is more common in runners and develops gradually during physical activity. Symptoms often include a dull, aching pain in the shin area that worsens with running, along with possible numbness, tingling, or weakness in the foot. Pain typically subsides after rest, distinguishing it from more urgent acute cases.

The underlying mechanism in CECS is thought to involve muscle expansion during exercise, which increases compartment pressure beyond what the fascia can accommodate. This impedes blood flow and compresses nerves, resulting in the hallmark pain and neurological symptoms. Risk factors for runners include overtraining, improper footwear, and running on hard or uneven surfaces. Biomechanical factors such as overpronation or muscle imbalances may also contribute to the development of the syndrome, making it a multifactorial condition.

Management strategies depend on severity. Conservative approaches include activity modification, gait retraining, physiotherapy, and shoe adjustments to reduce repetitive strain. However, these measures may provide only temporary relief for some athletes. In refractory cases, surgical fasciotomy, which involves releasing the fascia to relieve pressure, may be necessary and has shown high success rates in returning athletes to sport. Early recognition is critical, as untreated compartment syndrome—especially the acute form—can result in permanent muscle and nerve damage.

Most Useful Resources:
Anterior Compartment Syndrome (PodiaPaedia)
Effects of forefoot running on chronic exertional compartment syndrome (Podiatry Arena)
Chronic Exertional Compartment Syndrome (Podiatry Arena)
Should we transition all anterior compartment syndromes to forefoot striking? (Running Research Junkie)
Compartment Syndrome of the Anterior Leg in Runners (Runners Space)
Compartment Syndrome (Foot Health Forum)

Baxter nerve entrapment is a cause of heel pain with the symptoms often mimicking plantar fasciitis and should be conisdered in any case of heel pain the has a neurological component to it.

Baxter’s nerve entrapment, also known as inferior calcaneal nerve entrapment, is a relatively common but often overlooked cause of chronic heel pain. The Baxter’s nerve is the first branch of the lateral plantar nerve, and it runs beneath the abductor hallucis muscle before traveling along the medial side of the heel. Because of its position, it is vulnerable to compression as it passes between surrounding structures, particularly the abductor hallucis and the medial calcaneal tuberosity. This entrapment can mimic or coexist with plantar fasciitis, which is why it is frequently misdiagnosed.

The clinical presentation of Baxter’s nerve entrapment usually involves sharp, burning, or radiating pain on the inside of the heel that may worsen with prolonged standing, walking, or running. Unlike classic plantar fasciitis, which is typically most painful during the first steps in the morning, Baxter’s nerve pain can persist throughout the day and sometimes worsens with activity. Patients may also report tingling or numbness along the heel or arch, as the compressed nerve is both sensory and motor. Chronic cases can even lead to weakness of the abductor digiti quinti muscle in the foot.

Risk factors and causes often include repetitive overuse in runners, foot deformities such as flat feet or overpronation, and tightness of the abductor hallucis muscle. External factors, like ill-fitting shoes or excessive standing on hard surfaces, can also contribute to entrapment. In many athletes, the combination of repetitive heel impact and biomechanical stress creates a perfect environment for irritation of the nerve. Because these symptoms overlap with plantar fasciitis, imaging such as MRI or ultrasound, along with careful physical examination, is usually needed to confirm the diagnosis.

Treatment strategies for Baxter’s nerve entrapment focus on reducing nerve compression and inflammation. Conservative options include rest, orthotic devices to correct foot mechanics, stretching of the calf and abductor hallucis, and targeted physical therapy. Anti-inflammatory medications or corticosteroid injections may be used in persistent cases. For patients who do not respond to conservative care, surgical decompression of the nerve can be considered, which generally provides significant relief. Early recognition is important, as untreated entrapment can lead to chronic heel pain and functional limitations.

Most Useful Resources:
Baxters Nerve Entrapment (PodiaPaedia)
Baxter’s Neuritis (Medial Calcaneal Nerve Neuritis) (Podiatry Arena)
Baxter’s neuropathy secondary to plantar fasciitis (Podiatry Arena)
Baxters Nerve Entrapment (Podiatry TV)
Baxters nerve or plantar fasciitis? (Podiatry Experts)
Baxters Nerve Entrapment (Foot Health Forum)