Keys To Addressing Compartment Syndrome

When it comes to compartment syndrome, trauma is the most common cause. The most common traumatic cause is fracture but compartment syndrome can also occur with burns. The injury causes compartment syndrome due to increased swelling from fluid within the compartment.1,2

Overuse injuries in exercise can also factor into compartment syndrome but the incidence is miniscule in comparison to trauma.

The literature varies on the number of compartments in the foot but the consensus involves the following: the medial, lateral, central (including the superficial and deep compartments) and interosseous compartments.1,3

What is the clinical presentation of compartment syndrome? Severe pain that is out of proportion to the injury is the hallmark sign. The six Ps of compartment syndrome are:

1. pulselessness
2. pallor
3. paresthesias
4. pain
5. paralysis
6. poikilothermia

What diagnostic tests are helpful? One clinical test is flexing/extending the digits and seeing if there is increased pain. This is considered apathognomonic sign. Another more invasive test is to use a wick catheter. A wick catheter is essentially a needle with a pressure measuring gauge attached to it. You place the needle within the compartments and take a reading. Normal compartment pressures are below 30 mmHg. Compartment syndrome is defined as a pressure exceeding 30 mmHg or 10 to 30mmHg below the diastolic pressure.1,2

Residual deformity from compartment syndrome may result in severe contractures of the foot (claw toes), weakness, sensory loss and permanent loss of function.1,3 If compartment syndrome is left untreated, it can lead to neural deficits and possible muscle necrosis.3

The only treatment for compartment syndrome is surgery.1-4 The aim of surgery is to open up the compartments involved and release the pressure.

There are designated incision sites that allow you to access as many compartments as possible through that incision. Oftentimes, you will choose to use three incisions (two on the top of the foot and one on the inside). Incisions are site specific.

References
1. Coughlin MJ, Mann RA, Saltzman CL (eds). Surgery of the Foot and Ankle, 8th edition. Mosby, Philadelphia, 2007.
2. Banks AS, Downey MS, Martin DE (eds). McGlamry’s Foot and Ankle Surgery, 3rd edition. Lippincott, Williams & Wilkins, Philadelphia, 2001.
3. Fulkerson E, Razi A, Tejwani N. Review: acute compartment syndrome of the foot. Foot Ankle Int. 2003;24(2):180-7.
4. Reach JS Jr, Amrami KK, Felmlee JP, Stanley DW, Alcorn JM, Turner NS. The compartments of the foot: a 3-tesla magnetic resonance imaging study with clinical correlates for needle pressure testing. Foot Ankle Int. 2007;28(5):584-94.



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