The anterior compartment of the leg is bounded by the tibia medially, fibula laterally, interosseous membrane posteriorly, and crural fascia anteriorly. It contains tibialis anterior, extensor hallucis longus, extensor digitorum longus, fibularis tertius, the deep peroneal nerve, and the anterior tibial artery. Normal resting pressure is below 10 mmHg.
| Location | Front of the leg, between the tibia and fibula |
|---|---|
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Holds the ankle dorsiflexors and toe extensors in a tight sleeve that improves their pull. Because the walls barely stretch, swelling here quickly raises pressure, making it the commonest site of compartment syndrome.
Acute anterior compartment syndrome is the most common compartmental emergency of the lower leg, occurring after tibial fractures, crush injury, or reperfusion. Intracompartmental pressure above 30 mmHg or within 30 mmHg of diastolic pressure warrants immediate fasciotomy. Chronic exertional compartment syndrome produces reproducible exercise-induced anterior shin pain relieved by rest, diagnosed by post-exercise pressure measurement.
Rapidly rising intracompartmental pressure after tibial fracture or crush injury producing the five Ps, requiring emergency four-compartment fasciotomy.
Reversible pressure elevation in the anterior compartment during exercise causing activity-related leg pain and foot drop, treated by fasciotomy release when conservative measures fail.
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