title: Forefoot running improves pain and disability associated with chronic exertional compartment syndrome.
abstract: BACKGROUND
  Anterior compartment pressures of the leg as well as kinematic and kinetic measures are significantly influenced by running technique. It is unknown whether adopting a forefoot strike technique will decrease the pain and disability associated with chronic exertional compartment syndrome (CECS) in hindfoot strike runners.
  
  
  OBJECTIVE
  For people who have CECS, adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Ten patients with CECS indicated for surgical release were prospectively enrolled. Resting and postrunning compartment pressures, kinematic and kinetic measurements, and self-report questionnaires were taken for all patients at baseline and after 6 weeks of a forefoot strike running intervention. Run distance and reported pain levels were recorded. A 15-point global rating of change (GROC) scale was used to measure perceived change after the intervention.
  
  
  RESULTS
  After 6 weeks of forefoot run training, mean postrun anterior compartment pressures significantly decreased from 78.4 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Vertical ground-reaction force and impulse values were significantly reduced. Running distance significantly increased from 1.4 ± 0.6 km before intervention to 4.8 ± 0.5 km 6 weeks after intervention, while reported pain while running significantly decreased. The Single Assessment Numeric Evaluation (SANE) significantly increased from 49.9 ± 21.4 to 90.4 ± 10.3, and the Lower Leg Outcome Survey (LLOS) significantly increased from 67.3 ± 13.7 to 91.5 ± 8.5. The GROC scores at 6 weeks after intervention were between 5 and 7 for all patients. One year after the intervention, the SANE and LLOS scores were greater than reported during the 6-week follow-up. Two-mile run times were also significantly faster than preintervention values. No patient required surgery.
  
  
  CONCLUSIONS
  In 10 consecutive patients with CECS, a 6-week forefoot strike running intervention led to decreased postrunning lower leg intracompartmental pressures. Pain and disability typically associated with CECS were greatly reduced for up to 1 year after intervention. Surgical intervention was avoided for all patients.
authors.affiliation: Keller Army Community Hospital, West Point, NY 10996, USA. angie.diebal@us.army.mil
authors.forename: Angela R
authors.initials: AR
authors.lastname: Diebal
authors.forename: Robert
authors.initials: R
authors.lastname: Gregory
authors.forename: Curtis
authors.initials: C
authors.lastname: Alitz
authors.forename: J Parry
authors.initials: JP
authors.lastname: Gerber
mesh_terms: D000328:Adult; D000868:Anterior Compartment Syndrome / Q000150:complications / Q000628:therapy*; D001696:Biomechanical Phenomena; D002908:Chronic Disease; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005545:Forefoot, Human; D006801:Humans; D007700:Kinetics; D008297:Male; D059352:Musculoskeletal Pain / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012420:Running / Q000502:physiology*; D057566:Self Report; D016896:Treatment Outcome