- Discussion:
- compartment syndromes can occur in the foot as in other parts of body;
- mechanism of injury is severe local trauma, & assoc skeletal injury may be minimal;
- classic symptoms & signs are progressive pain, numbness in toes, and decreased motion, however, these are the same symptoms that one would
expect to find w/ concomitant foot fractures and injury;
-
tense tissue bulging may be the most reliable symptom;
- compartmental pressures will be elevated;
- note that compartment syndromes of the foot are associated w/ compartment syndromes of the
deep posterior compartment;
- Anatomy:
- the 9 compartments of the foot can be placed into 4 groups;
-
Intrinsic Compartment:
- 4 intrinsic muscles between the 1st and 5th metatarsals;
-
Medial Compartment:
-
abductor hallucis;
-
flexor hallucis brevis;
-
Central Compartment: (Calcaneal Compartment)
-
flexor digitorum brevis;
-
quadratus plantae;
-
adductor hallucis;
-
Lateral Compartment:
- flexor digiti minimi brevis;
- abductor digiti minimi;
- Clinical Findings:
- pain alone is not sufficient for diagnosis;
- increased pain on passive dorsiflexion of metatarsophalangeal joints is key finding (indicating myoneural ischemia in intrinsic muscles);
- poor capillary refill and absent pulses are late findings.
- in the presence of massive swelling of the foot, which usually accompanies these injuries, pulses are usually not palpable.
- Surgical Treatment:
- appropriate treatment for a suspected compartment syndrome of the foot is immediate and complete fasciotomy;
-
abductor hallucis longus, central, lateral, and interosseous compartments must be released;
- effective decompression of all 4 compartments can be accomplished thru medial longitudinal Henry approach, or thru 2 parallel dorsal
incision along the lengths of the second and fourth metatarsals;
-
medial approach:
- this is usually the approach of choice;
- can be used to decompress the medial and central compartments as well as the remaining foot compartments;
- extends from a point below the medial malleolus (3 cm from the sole) to proximal aspect of first metatarsal;
- once the neurovascular bundle has been retracted out of the way, the fascia overlying the
abduction hallucis and
FDB is released;
- medial intermuscular septum is opened longitudinally;
- the lateral plantar neurovascular bundle is found coursing over the
quadratus plantae (central compartment) as they course laterally;
- the remaining compartments (central, lateral, intrinsic) are entered thru blunt dissection w/ a clamp;3
- lateral compartment is found by retracting the FDB out of the way;
-
dorsal approach:
- often the dorsal approach is not necessary unless there is concomitant metatarsal or
Lisfranc fractures;
- accomplished through 2 dorsal incisions centered just medial to the 2nd metatarsal and just lateral to the 4th metatarsals (to maximize skin bridge);
- avoid injury to sensory nerves and extensor tendons;
- superficial fascia is divided and interosseous are elevated off the metatarsals to further decompress the compartments;
- clamp is used to bluntly dissect thru the central, medial, and lateral compartments;
- separate medial incision may be needed to release the abductor;
- fasciotomy incisions may be used for fracture fixation;
--------------------------------------------
Management of compartment syndromes of the foot.
Compartment syndrome of the foot after intraarticular calcaneal fracture.
Ankle and foot fasciotomy: an adjunctive [1mtechnique [m to optimize limb salvage after revascularization for acute ischemia.
Compartment syndromes of the foot after calcaneal fractures.
Compartment syndrome of the foot in children.
Compartment syndrome of the foot in children [see comments].
Technique Tip: Use of “Pie Crusting” of the Dorsal Skin in Severe Foot Injury
Acute Foot Compartment Syndromes. AJ Fakhouri and A Manoli J. Orthop. Trauma. Vol 6. No 2, pp 223-228. 1992.
Bonutti PM, Bell GR: Compartment syndrome of the foot. J Bone Joint Surg 1986;68(A):1449.
Loeffler RD, Ballard A: Plantar fascial spaces of the foot and proposed surgical approach. Foot Ankle 1980;1:11.
Myerson MS: Experimental basis for fasciotomy of the foot and decompression in acute compartment syndromes. Foot Ankle 1988;8:308-314.
Myerson M: Compartment syndromes of the foot. Bull Hosp Jt Dis Orthop Inst 1987;47:251-261.
Karlestrom G, Lonnerholm T, Olerud S: Cavus deformity of the foot after fracture of the tibial shaft. J Bone Joint Surg (Am) 1975;57A:893-900.
Matsen FA, Clawson DK: The deep posterior compartmental syndrome of the leg. J Bone Joint Surg (Am) 1975;57A:34-39.
