What should I do if I have leg pain with tight muscle squeezing upon movement after a fall?

Acute Post-Fall Leg Pain Management

You need immediate evaluation to rule out compartment syndrome, which is a surgical emergency that can cause permanent muscle and nerve damage if not treated within hours. 1

Immediate Actions Required

Remove any tight clothing, bandages, or compression garments immediately and position your leg at heart level (not elevated). 1, 2 Elevating the limb can worsen tissue perfusion if compartment syndrome is developing. 1

Seek emergency medical evaluation if you experience:

• Pain that seems worse than expected for the injury (pain out of proportion) - this is the earliest warning sign of compartment syndrome 1
• Increasing pain when you try to move your toes or ankle passively (someone else moves them for you) - this is highly sensitive for compartment syndrome 1
• Progressive tightness or firmness in your leg muscle 1
• Numbness, tingling, or weakness developing in your foot - these indicate nerve compromise 1

What Your Doctor Will Assess

Your physician will evaluate for compartment syndrome by checking:

• Pain severity relative to the injury mechanism - severe pain gives only 25% diagnostic accuracy alone, but combined with pain on passive stretch increases accuracy to 68% 1
• Pain when your ankle/toes are passively stretched - this is considered the most sensitive early clinical sign 1
• Compartment tension on palpation - though this has limited reliability (54% sensitivity) 1, 2
• Sensory and motor function in your foot - deficits indicate advanced tissue damage 1

If clinical diagnosis remains uncertain, direct compartment pressure measurement is the only validated diagnostic tool. 2 Fasciotomy (surgical release) is indicated when compartment pressure ≥30 mmHg or when the difference between your diastolic blood pressure and compartment pressure is ≤30 mmHg. 2

Initial Pain Management

While awaiting evaluation, appropriate pain control includes:

• Acetaminophen (paracetamol) as first-line treatment for mild-to-moderate pain 3
• Ice application to reduce swelling (standard RICE protocol for muscle strain) 4
• Avoid NSAIDs initially until compartment syndrome is definitively ruled out, as they may mask worsening symptoms 3

If Compartment Syndrome Is Ruled Out

Once compartment syndrome is excluded, your injury is likely a muscle strain or contusion. Management includes:

• Rest from aggravating activities for 48-72 hours 4
• Ice, compression (if tolerable), and NSAIDs once compartment syndrome is excluded 4
• Gentle range-of-motion exercises as pain permits, avoiding prolonged immobilization which causes muscle deconditioning 3
• Progressive physical therapy to restore flexibility and strength as swelling subsides 4

Critical Pitfalls to Avoid

Do not wait for late signs like loss of pulse, pale skin, or complete inability to move your foot - these indicate irreversible tissue damage has already occurred. 1, 2 Young patients with high-energy trauma are at highest risk for compartment syndrome. 1

Do not rely on the ability to feel pulses in your foot to rule out compartment syndrome - pulses remain present until very late stages. 1

Do not elevate your leg above heart level if compartment syndrome is suspected - this decreases perfusion pressure and worsens ischemia. 1, 2

The typical recovery timeline for uncomplicated muscle strain is excellent with few complications, but this requires ruling out compartment syndrome first. 4