I have a history of runner's compartment syndrome and I'm experiencing severe bilateral leg pain, numbness, tingling, and paresthesia while taking Adderall (amphetamine and dextroamphetamine) - what should I do?

Stop Taking Adderall Immediately and Seek Emergency Care Now

You need to go to the emergency department immediately—your symptoms suggest possible acute compartment syndrome, which is a limb-threatening emergency that requires urgent evaluation and potentially emergency surgery within hours to prevent permanent nerve and muscle damage. 1, 2

Why This Is an Emergency

• Pain out of proportion to injury is the earliest and most reliable warning sign of acute compartment syndrome, and your severe bilateral leg pain fits this pattern 1
• Numbness, tingling, and paresthesia indicate nerve ischemia is already occurring, which means tissue damage is progressing 1, 3
• Bilateral involvement is particularly concerning because it suggests a systemic trigger (like your Adderall) may be contributing to vascular compromise in both legs 1
• Your history of runner's compartment syndrome puts you at higher risk for developing acute compartment syndrome with any additional vascular stress 4, 5

Adderall Connection

• Amphetamines cause vasoconstriction (narrowing of blood vessels), which can reduce blood flow to your leg compartments 1
• In someone with pre-existing compartment syndrome history, this vasoconstriction could tip you into acute compartment syndrome by further reducing the already compromised perfusion pressure in your leg compartments 1, 4
• Stop the Adderall immediately—do not take another dose until you've been evaluated by emergency physicians 1

What Will Happen in the Emergency Department

• They will perform urgent clinical examination looking specifically for pain with passive stretching of your leg muscles (the most sensitive early sign), firmness/tension of the compartments, and motor deficits 6, 1
• If diagnosis is uncertain, they will measure compartment pressures directly using needle manometry—fasciotomy (emergency surgery to release pressure) is indicated when compartment pressure ≥30 mmHg or when the difference between your diastolic blood pressure and compartment pressure is ≤30 mmHg 1
• If compartment syndrome is confirmed, you need immediate fasciotomy (surgical opening of the compartments) to prevent permanent damage—this is not something that can wait 1, 2

Critical Time Window

• Waiting for late signs like weakness, pallor, or absent pulses means significant irreversible tissue damage has already occurred 1, 3
• The longer elevated tissue pressure persists, the greater the potential for permanent nerve damage, muscle death, kidney failure from rhabdomyolysis, and even limb loss 4, 3
• Time is the critical factor—every hour of delay increases the risk of catastrophic outcomes 2

What NOT to Do

• Do not elevate your legs excessively—keep them at heart level, as elevation can further decrease perfusion pressure and worsen compartment syndrome 1
• Do not wait to see if symptoms improve—compartment syndrome does not resolve on its own and requires surgical intervention 1, 2
• Do not take more Adderall or any other stimulants that could worsen vasoconstriction 1

If You Cannot Get to the ED Immediately

• Call 911 if you develop weakness or inability to move your feet/toes—this indicates irreversible damage is imminent 4
• Remove any tight clothing, compression garments, or anything constricting your legs 1
• Position your legs at heart level (not elevated, not dependent) 1

This is not a "wait and see" situation. Your combination of symptoms—severe bilateral leg pain, numbness, tingling, paresthesia, history of compartment syndrome, and current Adderall use—creates a perfect storm for acute compartment syndrome. Go to the emergency department now.