Compartment Syndrome Foot

Incidence

 

10% of calcaneus fractures 

40% of crush injuries

 

Diagnosis

 

High index of suspicion / classic signs less reliable

 

Pain & pain with passive stretch remain the cardinal signs

- pallor, paresthesia, pulselessness, & paralysis occur later or sometimes not at all

- low threshold calcaneal compartment pressures & surgical exploration

 

Anatomy

 

Nerve supply sole of foot

 

1.  Medial calcaneal 

- posterior weight bearing surface

 

2.  Medial plantar

- medial 3 & 1/2 sensation

- AbdH, FHB, 1st lumbrical

 

3.  Lateral plantar

- lateral 1 & 1/2 

 

4 muscle layers of the foot

 

Layer 1 (3)

- 3 short muscles that cover the sole

- AbdDM, FDB, AbdH

 

Layer 2 (3)

- long tendons to the digits

- FDL, Flexor accessorius, FHL

 

Layer 3 (3)

- short muscles of the digits

- FHB, AddH, FDMB

 

Layer 4 (3)

- plantar / dorsal interossei and tendons

- P longus, T posterior & interossei

 

4 Compartments

 

Septae from the plantar fascia

- insert 1st and 5th metatarsals

- separate medial / calcaneal and lateral compartments

 

1. Medial 

- ABDH & FHB 

 

2. Central / Calcaneal compartment

- superficial: FDB

- deep: ADDH / F accessorius

 

3. Lateral 

- FDM & AbDDM

 

4. Interosseous 

- interossei

 

The calcaneal compartment communicateswith the deep post compartment of the leg through the medial retro-malleolar space

 

Management

 

3 incision emergent decompression

 

Two dorsal longitudinal incisions

- medial aspect of the 2nd MT

- lateral aspect of the 4th MT 

- release interossei compartments

 

One 6-cm medial incision

- begins at the post margin of MM

- distally along the sole 

- open ABDH & 1st MT interval

- release medial / calcaneal / lateral compartments

- DPC or split-thickness skin grafting at 5 days

 

Non Treated Compartment Syndrome

 

Deformities

- claw toes

- cavus

- FDL tethering

 

DDx / Posterior leg compartment syndrome / FDL involvement

- if the deformity decreases with PF of ankle

- FDL muscle & deep post compartment of leg are involved