I have a history of runner's compartment syndrome and I've been experiencing numbness, tingling, and pressure in my legs while taking Adderall (amphetamine and dextroamphetamine), should I be concerned?

Adderall and Compartment Syndrome: Immediate Evaluation Required

You need to stop taking Adderall immediately and seek urgent medical evaluation, as amphetamines can cause vasoconstriction that may worsen compartment syndrome or trigger acute-on-chronic compartment syndrome in someone with your history. 1, 2

Why This Is Concerning

Amphetamine Effects on Vascular Perfusion

• Amphetamines like Adderall cause peripheral vasoconstriction, which reduces blood flow to the extremities 3
• In someone with a history of compartment syndrome, this vasoconstriction can critically reduce the already compromised perfusion pressure in affected muscle compartments 1, 4
• Your symptoms of numbness, tingling, and pressure are classic early warning signs of compartment syndrome progression 3, 1, 4

Your Specific Risk Profile

• History of runner's compartment syndrome places you at high risk for recurrence, particularly with any factor that reduces muscle perfusion 5, 6, 7
• Patients with prior compartment syndrome have altered compartmental dynamics that make them vulnerable to repeat episodes 5, 7
• The combination of exercise (running) plus a vasoconstricting medication creates a dangerous synergy 2, 6

Critical Warning Signs You're Experiencing

Current Symptoms Analysis

• Numbness and tingling are early neurological signs indicating nerve ischemia from elevated compartmental pressure 3, 1, 4
• The "pressure" sensation you describe reflects increased tissue pressure within the fascial compartment 4, 8
• The fact that severe pain has improved does NOT mean you're safe—numbness can indicate progression to nerve damage 3, 1

Dangerous Misconception

• Never assume improvement in pain means the problem is resolving—in compartment syndrome, decreasing pain with increasing numbness often signals nerve death from prolonged ischemia 1, 8
• Sensory changes (numbness/tingling) indicate you're already experiencing nerve compromise 3, 1, 4

Immediate Action Plan

Step 1: Stop Adderall Now

• Discontinue amphetamine immediately to remove the vasoconstricting stimulus 3, 1
• Do not resume without clearance from both your prescribing physician and a vascular or orthopedic specialist 1, 2

Step 2: Urgent Medical Evaluation

• Seek same-day evaluation by an orthopedic surgeon or emergency department 1, 8
• Request compartment pressure measurement if clinical suspicion remains after examination 1, 8
• Fasciotomy is indicated if compartment pressure ≥30 mmHg or if differential pressure (diastolic BP minus compartment pressure) is ≤30 mmHg 1, 9

Step 3: Immediate Self-Care While Awaiting Evaluation

• Position your legs at heart level—do NOT elevate them, as this further reduces perfusion pressure 1
• Remove any constrictive clothing, compression socks, or tight footwear 1
• Stop all running and exercise until cleared 5, 6, 7

What the Doctor Should Assess

Clinical Examination Priorities

• Pain with passive stretch of leg muscles is the most sensitive early clinical sign (when combined with your symptoms, diagnostic probability reaches 68%) 1, 2
• Check for increasing firmness/tension of the leg compartments 1
• Assess motor function—any weakness moving your foot or toes is a late sign indicating irreversible damage may be occurring 1, 2, 8
• Evaluate pulses and capillary refill, though absence is a very late finding 1, 8

Diagnostic Testing

• Direct compartment pressure measurement using needle manometry is indicated given your history and current symptoms 1, 8, 6
• Pressure ≥30 mmHg or differential pressure ≤30 mmHg mandates urgent fasciotomy 1, 9

Long-Term Management Considerations

Regarding Adderall Use

• Alternative ADHD medications should be strongly considered if you need to continue treatment 3
• Non-stimulant options like bupropion or viloxazine do not cause the same degree of vasoconstriction 3
• If stimulants are deemed essential, you may need to permanently cease running or accept surgical fasciotomy as definitive treatment 5, 7

Chronic Exertional Compartment Syndrome Management

• Conservative management includes cessation of running activities, physical therapy, altering foot-strike pattern, and orthotics 5, 6
• Surgical fasciotomy has high success rates (approximately 80%) for athletes wanting to maintain activity levels 5, 7
• Endoscopy-assisted compartment release is a newer minimally invasive option with high success and low complication rates 5

Critical Pitfalls to Avoid

• Do not wait for severe pain to return—progressive numbness with decreased pain can indicate advancing nerve death 1, 8
• Do not continue exercising thinking the problem has resolved because pain improved 5, 6
• Do not restart Adderall without specialist clearance, as recurrent episodes cause cumulative permanent damage 1, 2, 4
• Do not delay evaluation beyond 24 hours—untreated compartment syndrome leads to permanent muscle and nerve damage, limb loss, kidney failure from rhabdomyolysis, and potentially death 2, 4, 8