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Final Program


Final Program

624 - Botox Injections for Chronic Exertional Compartment Syndrome

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • AB

    Abigail Bideaux, MD

    PGY3 Resident
    University of Virginia
    Charlottesville, Virginia, United States

    • Co-Author(s)

  • DH

    David Hryvniak, DO

    Associate Professor
    University of Virginia
    Charlottesville, Virginia, United States

Case Diagnosis: Chronic exertional compartment syndrome

Case Description: A 38-year-old female presented with a one-year history of severe pain in the anterior left lower extremity and great toe numbness within minutes of beginning aerobic activity. Compartment testing was notable for elevated pre-exercise pressures in both the anterior and lateral compartments, and elevated post-exercise pressure in the anterior compartment. The patient did not have significant improvement in symptoms with physical therapy. MRI showed no abnormality to explain symptoms. A total of 62.5 units of botulinum toxin were injected into the tibialis anterior (25 units at two different sites) and extensor digitorum longus (12.5 units) under ultrasound guidance. At six-week follow up, the patient reported marked improvement, endorsing only mild pain with walking. On exam, left ankle dorsiflexion strength was slightly reduced (4+/5) compared to the right (5/5). She was able to complete a gradual return to exercise plan that included walking and stationary biking.

Discussions: Botox injections are an emerging treatment for chronic exertional compartment syndrome (CECS). In a study of botox injections performed for CECS, 15 of 16 patients had complete resolution of their symptoms for up to nine months. According to a recent systematic review of complications associated with fasciotomy for CECS, rates were found to be 2.7%- 22.5% for hematomas, 2.0%-18.6% for nerve injuries, 2.7% for DVT, and 0.65%-8.4% for symptom recurrence.

Conclusions:


  1. Botox injections may be a safer alternative to fasciotomy for treatment of CECS.



  2. Recommend starting with low doses to avoid iatrogenic weakness. 



  3. Further research is needed to determine optimal treatment protocol.