The posterior compartment of the leg is divided into superficial (gastrocnemius-soleus complex) and deep (tibialis posterior, FDL, FHL) components by the deep transverse fascia. The space between these layers contains the posterior tibial neurovascular bundle and is the site of deep posterior compartment syndrome.
The deep posterior compartment space contains the tibial nerve, posterior tibial artery, and the three deep flexor muscles in a relatively tight fascial envelope. Exertional or traumatic compartment syndrome in this space produces insidious calf tightening, rest pain, and posterior tibial nerve symptoms including plantar numbness. Fasciotomy of the deep posterior compartment requires incision of the deep transverse fascia in addition to the crural fascia.
Pressure elevation in the deep posterior leg space from exercise or trauma producing tibial nerve compression with plantar foot numbness and FHL/FDL weakness, requiring emergency four-compartment leg fasciotomy.
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