This is something that I just used to hate seeing. Conservative treatments for this were generally unsatisfactory and surgery was always a good option (and not that difficult). Now we are in a different position as transitioning those with anterior compartment syndrome to a midfoot or forefoot strike and increasing the cadence is reducing the load in the anterior tibial muscle to the point where almost every case I have seen recently has got better without surgery! The actual evidence for this is weak and makes a good case study on when should clinicians change clinical practice when the evidence is weak. I blogged about this here.