Effect of Non-Surgical Treatments on Intracompartmental Pressures in Service Members with Chronic Exertional Compartment Syndrome- MHSRS 2026

T velasco, n reilly, c hulsopple, r boeth, k roberts, d hoellen, c dickison, d goss, j leggit

Abstract accepted for poster presentation at the 2026 Military Health System Research Symposium (MHSRS)

Introduction: Chronic exertional compartment syndrome (CECS) significantly limits the running capacity and operational readiness of active-duty service members (ADSMs) and often leads to medical discharge. While fasciotomy is the traditional standard treatment, its success in the military population has mixed results. Emerging non-surgical treatments include Botulinum toxin A (BoTN-A) and gait retraining. This clinical trial investigated the effects of these interventions on intra-compartmental pressures (ICP) the current diagnostic gold standard for diagnosis. 

Materials and Methods: 35 ADSMs with suspected CECS underwent ICP testing of the anterior compartment (AC) and lateral compartment (LC). Participants were randomized into a 2x2 factorial design: injection (BoTN-A vs normal saline injection) and gait retraining (supervised gait retraining (SGR) vs home-based gait retraining (HBGR). ICP was measured at baseline and six months post-intervention. A positive diagnosis was defined by Pedowitz criteria.

Results: At baseline, a total of 65 legs and 37 legs met Pedowitz criteria for AC and LC CECS, respectively. While AC pressures showed no significant differences between intervention groups over time, LC pressures demonstrated significant reductions. Specifically, the BoTN-A + HBGR showed statistically significant decreases in LC pressures from baseline to 6 months (p < 0.05). Furthermore, the BoTN-A + SGR group trended toward lower pressures compared to saline-control groups at the 6-month follow-up.                                                                                                                 

Conclusions: These findings suggest that non-surgical interventions can successfully reduce ICP in ADSMs with CECS, particularly in the lateral compartment. The combination of BoTN-A and gait retraining may provide a viable alternative to surgery, potentially improving functional outcomes. These results support the integration of multimodal conservative management to maintain the tactical athlete’s adherence to readiness standards and ability to deploy.