A literature review exploring the use of botulinum toxin A injection therapy for chronic exertional compartment syndrome treatment

Abstract

Chronic exertional compartment syndrome (CECS) is a rare condition typically affecting runners. It has been speculated that the cause of CECS is due to a transient ischemia occurring during exercise compromising blood flow and leading to increased intramuscular pressure. The first line of treatment for patients is cessation of the aggravating activity which some individuals are less inclined to follow. If conservative treatment fails, the next option is a fasciotomy with a recurrence risk of 44.7%. A review of current literature on treatment options for CECS illustrates preliminary studies of the use of botulinum toxins A injection therapy. The use of botulinum toxin A as a non-surgical option for CECS has been theorized due to the analgesic properties and muscle hypotonia to improve blood flow. The objective of this review was to search the current literature on the use of botulinum toxin A as a treatment option for patients with CECS. A thorough search of the literature via PubMed concerning botulinum toxin as a treatment option for patients with CECS was completed. Botulinum toxin A injections demonstrate a statistically significant decrease in intramuscular pressure in the anterior and lateral compartments of the leg. A high correlation is noted in patients experiencing no exertional pain extending to fourteen months following the injections with no reported adverse effects. Patients were able to resume and continue pre-injections level of activity without any residual effects. Our goal was to investigate the current literature for non-surgical treatments for CECS. The effectiveness of this potential therapy both short term and long term are not fully understood as of yet, however future large prospective randomized controlled studies are needed.