Meli, Gabrielle M

Background: Chronic exertional compartment syndrome (CECS) is an often-overlooked cause of exertional lower leg pain that is frequently misdiagnosed. Overlapping symptoms and inconsistent diagnostic approaches may delay diagnosis and prolong morbidity. The purpose of this study was to characterize the diagnostic journey of patients ultimately treated surgically for CECS and to report postoperative outcomes. Methods: A retrospective chart review was performed following IRB approval. Patients diagnosed with CECS and treated operatively by the senior author between 2020 and 2025 were identified using Current Procedural Terminology ( CPT ), International Classification of Diseases, Ninth and Tenth Revision ( ICD-9 and ICD-10 ) codes. Demographics, symptom duration, prior diagnostic workup, operative details, and postoperative outcomes were collected. Median follow-up was 42 weeks (range, 15-184 weeks). Descriptive statistics were reported. Results: Thirteen patients met inclusion criteria (mean age, 27.3 years; mean BMI, 28.3). Mean symptom duration prior to definitive diagnosis was 51.5 months, and bilateral symptoms were present in 12 patients. Most patients underwent extensive diagnostic testing and multiple unsuccessful conservative treatment strategies before referral. All patients underwent endoscopic-assisted anterolateral compartment release, with open posterior compartment fasciotomy performed when clinically indicated. Nine patients underwent bilateral procedures. At final follow-up, all patients reported symptomatic improvement and return to baseline activity. Four patients required additional evaluation for persistent posterior compartment symptoms, and 2 ultimately underwent further posterior compartment release. There were no intraoperative complications. Conclusion: CECS remains a frequently delayed diagnosis because of nonspecific symptoms, substantial overlap with other causes of exertional lower-leg pain, and limitations of currently available diagnostic tools. Although the effect of diagnostic delay on postoperative outcomes could not be directly assessed, prolonged delays were associated with substantial diagnostic burden and management complexity. Following fasciotomy, all patients reported symptomatic improvement and return to baseline activity. Greater awareness of CECS and a structured diagnostic approach may help facilitate earlier recognition and treatment. Level of Evidence: Level IV, retrospective case series.

Background: Midfoot arthritis can cause debilitating dorsal midfoot pain and functional limitation. Deep peroneal nerve (DPN) neurectomy is a minimally invasive surgical option that addresses pain through selective denervation. Although favorable midterm outcomes have been reported, long-term durability remains unclear. The purpose of this study was to evaluate changes in patient-reported physical function and pain interference between midterm and long-term follow-up after DPN neurectomy using validated Patient-Reported Outcomes Measurement Information System (PROMIS) instruments. Methods: A retrospective review identified patients who underwent isolated DPN neurectomy for midfoot arthritis between 2017 and 2021 and completed PROMIS Physical Function (PF) and Pain Interference (PI) questionnaires at midterm and long-term follow-up. Mean follow-up was 2.9 years (midterm) and 6.1 years (long-term). PROMIS scores were compared using paired t tests. Clinically meaningful improvement was defined using established minimal clinically important difference (MCID) thresholds (+5.88 for PF, −5.49 for PI). Results: The final cohort included 32 patients (81.2% female, mean age 68.4 ± 7.3 year). PF improved from 37.7 ± 6.2 to 39.0 ± 7.5 (Δ = +1.3, 95% CI [−0.7 to +3.4], P = .188), whereas PI decreased from 62.6 ± 8.8 to 59.2 ± 9.0 (Δ = −3.4, 95% CI [−6.3 to −0.5], P = .020). Clinically meaningful improvement was achieved by 7 of 32 (21.9%) for PF and 15 of 32 (46.9%) for PI. Five patients experienced clinically meaningful worsening, including patients with stroke, chronic pain syndrome, or contralateral foot and ankle pathology or surgery. Conclusion: DPN neurectomy was associated with stable longitudinal PROMIS outcomes through extended follow-up, with a nonsignificant mean PF change of +1.3 points and a statistically significant but sub-MCID mean PI decrease of −3.4 points over approximately 6 years. Outcomes were heterogeneous; fewer than half of patients achieved clinically meaningful improvement in pain interference, and a subset experienced worsening. These findings suggest that DPN neurectomy may provide durable symptom stability in appropriately selected patients with refractory dorsal midfoot pain, although clinically meaningful benefit at the individual level is not universal. Level of Evidence: Level III, comparative series.