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